Provider Demographics
NPI:1417618521
Name:MASON, TAMEISHA LYNELLE
Entity Type:Individual
Prefix:
First Name:TAMEISHA
Middle Name:LYNELLE
Last Name:MASON
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 1:2402 CLIFTON ST NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-3562
Mailing Address - Country:US
Mailing Address - Phone:540-676-8625
Mailing Address - Fax:
Practice Address - Street 1:2402 CLIFTON ST NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-3562
Practice Address - Country:US
Practice Address - Phone:540-701-2110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-02
Last Update Date:2022-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy