Provider Demographics
NPI:1174182893
Name:MESHESHA, TIGIST KASSHUN
Entity Type:Individual
Prefix:
First Name:TIGIST
Middle Name:KASSHUN
Last Name:MESHESHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIGIST
Other - Middle Name:KASSHUN
Other - Last Name:MESHESHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3522 NEXUS CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-4437
Mailing Address - Country:US
Mailing Address - Phone:202-813-7499
Mailing Address - Fax:
Practice Address - Street 1:CADIA HEALTHCARE WHEATOB
Practice Address - Street 2:4011 RANDOLPH RD
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:301-933-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
DCHHA14367374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide