Provider Demographics
NPI:1093964967
Name:RICHARDS-DYSON, TENNILLE A
Entity Type:Individual
Prefix:MRS
First Name:TENNILLE
Middle Name:A
Last Name:RICHARDS-DYSON
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 1:976 ROUSSEAU DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-4120
Mailing Address - Country:US
Mailing Address - Phone:585-347-4761
Mailing Address - Fax:
Practice Address - Street 1:976 ROUSSEAU DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-4120
Practice Address - Country:US
Practice Address - Phone:585-347-4761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist