Provider Demographics
NPI:1457816902
Name:CUFFIE, TRAVANTAE KHEDEEM
Entity Type:Individual
Prefix:
First Name:TRAVANTAE
Middle Name:KHEDEEM
Last Name:CUFFIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4428 DORSEY DR #58 2020 ALUMNI DR #4625
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29733-0001
Mailing Address - Country:US
Mailing Address - Phone:803-847-1914
Mailing Address - Fax:
Practice Address - Street 1:4428 DORSEY DR #58 2020 ALUMNI DR #4625
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29733-0001
Practice Address - Country:US
Practice Address - Phone:803-847-1914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer