Provider Demographics
NPI:1366850687
Name:CABELL, TERI TAVAISHA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TERI
Middle Name:TAVAISHA
Last Name:CABELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOLLAND AVE
Mailing Address - Street 2:APT. 12E
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1220
Mailing Address - Country:US
Mailing Address - Phone:347-265-8175
Mailing Address - Fax:
Practice Address - Street 1:55 HOLLAND AVE
Practice Address - Street 2:APT. 12E
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1220
Practice Address - Country:US
Practice Address - Phone:347-265-8175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3036441164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse