Provider Demographics
NPI:1225515331
Name:NORMAN, TAIHESHA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAIHESHA
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3607
Mailing Address - Country:US
Mailing Address - Phone:631-833-0147
Mailing Address - Fax:
Practice Address - Street 1:34 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3607
Practice Address - Country:US
Practice Address - Phone:631-833-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY753774163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse