Provider Demographics
NPI:1427558659
Name:MAGBY, TALESHA M
Entity Type:Individual
Prefix:
First Name:TALESHA
Middle Name:M
Last Name:MAGBY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TALESHA
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3949 GROSVENOR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44118-2315
Mailing Address - Country:US
Mailing Address - Phone:216-256-5217
Mailing Address - Fax:
Practice Address - Street 1:3949 GROSVENOR RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44118-2315
Practice Address - Country:US
Practice Address - Phone:216-256-5217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2917642374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2917642Medicaid