Provider Demographics
NPI:1093214397
Name:MCDONALD, TANEISHA LATOYA I
Entity Type:Individual
Prefix:
First Name:TANEISHA
Middle Name:LATOYA
Last Name:MCDONALD
Suffix:I
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 1:1010 116TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1539
Mailing Address - Country:US
Mailing Address - Phone:646-323-2558
Mailing Address - Fax:
Practice Address - Street 1:1010 116STREET
Practice Address - Street 2:
Practice Address - City:COLLEGEPOINT
Practice Address - State:NY
Practice Address - Zip Code:11356
Practice Address - Country:US
Practice Address - Phone:646-323-2558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY726701-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse