Provider Demographics
NPI:1114433117
Name:NASH-DAIS, TOMECO SHAVAUGHN (LSW)
Entity Type:Individual
Prefix:
First Name:TOMECO
Middle Name:SHAVAUGHN
Last Name:NASH-DAIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2047 PA-309
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104
Mailing Address - Country:US
Mailing Address - Phone:484-276-4646
Mailing Address - Fax:
Practice Address - Street 1:2047 PA-309, ALLENTOWN, PA 18104
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104
Practice Address - Country:US
Practice Address - Phone:484-276-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135008104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker