Provider Demographics
NPI:1083388201
Name:BURTON, TASHICA S
Entity Type:Individual
Prefix:
First Name:TASHICA
Middle Name:S
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:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:CHERITON
Mailing Address - State:VA
Mailing Address - Zip Code:23316-0263
Mailing Address - Country:US
Mailing Address - Phone:757-710-6156
Mailing Address - Fax:
Practice Address - Street 1:4216 BLUEBIRD RD
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-2596
Practice Address - Country:US
Practice Address - Phone:757-710-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver