Provider Demographics
NPI:1073289229
Name:RODRIGUEZ, TELISHIA SHANTE (NRCMA)
Entity Type:Individual
Prefix:
First Name:TELISHIA
Middle Name:SHANTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NRCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6228 GILLESPIE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3215
Mailing Address - Country:US
Mailing Address - Phone:267-326-1177
Mailing Address - Fax:215-422-3851
Practice Address - Street 1:6228 GILLESPIE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3215
Practice Address - Country:US
Practice Address - Phone:267-326-1177
Practice Address - Fax:215-422-3851
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy