Provider Demographics
NPI:1235891078
Name:BRONSON-HICKS, RASHEEDAH
Entity Type:Individual
Prefix:
First Name:RASHEEDAH
Middle Name:
Last Name:BRONSON-HICKS
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 1:6062 KINGSESSING AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19142-2425
Mailing Address - Country:US
Mailing Address - Phone:267-258-6722
Mailing Address - Fax:
Practice Address - Street 1:6062 KINGSESSING AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19142-2425
Practice Address - Country:US
Practice Address - Phone:267-258-6722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAEINMedicaid
PASSNMedicaid