Provider Demographics
NPI:1396186532
Name:QUAITES, TOYMEKA
Entity Type:Individual
Prefix:
First Name:TOYMEKA
Middle Name:
Last Name:QUAITES
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 1:8295 TOURNAMENT DR
Mailing Address - Street 2:150
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8906
Mailing Address - Country:US
Mailing Address - Phone:866-563-7772
Mailing Address - Fax:
Practice Address - Street 1:8295 TOURNAMENT DR
Practice Address - Street 2:150
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8906
Practice Address - Country:US
Practice Address - Phone:866-563-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001352133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered