Provider Demographics
NPI:1225716301
Name:BECKLEY, TERESA SHANAY (CRANIAL SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SHANAY
Last Name:BECKLEY
Suffix:
Gender:F
Credentials:CRANIAL SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2161
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-0810
Mailing Address - Country:US
Mailing Address - Phone:909-787-6534
Mailing Address - Fax:
Practice Address - Street 1:8285 SIERRA AVE STE 101
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3550
Practice Address - Country:US
Practice Address - Phone:909-414-2912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty