Provider Demographics
NPI:1235808312
Name:HOUSTON, TANYA JEANETTE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JEANETTE
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2547 NORRTH MORELAND BLVD
Mailing Address - Street 2:B2
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120
Mailing Address - Country:US
Mailing Address - Phone:216-394-9959
Mailing Address - Fax:
Practice Address - Street 1:2547 NORRTH MORELAND BLVD
Practice Address - Street 2:B2
Practice Address - City:SHAKER HTS
Practice Address - State:OH
Practice Address - Zip Code:44120
Practice Address - Country:US
Practice Address - Phone:216-394-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health