Provider Demographics
NPI:1215824511
Name:EDEMAH, TESSY O (COSMETOLOGIST)
Entity type:Individual
Prefix:
First Name:TESSY
Middle Name:O
Last Name:EDEMAH
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:TESSY
Other - Middle Name:O
Other - Last Name:EDEMAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TPOSH SIGNATURES
Mailing Address - Street 1:1822 MANOR DR APT B
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4613
Mailing Address - Country:US
Mailing Address - Phone:862-704-5668
Mailing Address - Fax:862-704-5668
Practice Address - Street 1:1822 MANOR DR APT B
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4613
Practice Address - Country:US
Practice Address - Phone:862-704-5668
Practice Address - Fax:862-704-5668
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NH19270300374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide