Provider Demographics
NPI:1093584013
Name:RASHFORD, TANYA SIMONE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:SIMONE
Last Name:RASHFORD
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 683
Mailing Address - Street 2:
Mailing Address - City:POCONO SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18346-0683
Mailing Address - Country:US
Mailing Address - Phone:570-972-9041
Mailing Address - Fax:
Practice Address - Street 1:3324 PA ROUTE 940
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344
Practice Address - Country:US
Practice Address - Phone:272-219-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver