Provider Demographics
NPI:1073145579
Name:BURTON, TAYAISHA
Entity Type:Individual
Prefix:
First Name:TAYAISHA
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SHERWOOD FRST APT B
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5733
Mailing Address - Country:US
Mailing Address - Phone:347-622-0347
Mailing Address - Fax:
Practice Address - Street 1:255 SOUTH RD
Practice Address - Street 2:
Practice Address - City:STANFORDVILLE
Practice Address - State:NY
Practice Address - Zip Code:12581-6124
Practice Address - Country:US
Practice Address - Phone:845-337-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse