Provider Demographics
NPI:1518660661
Name:HARRIS, TASHEKA JANAY
Entity Type:Individual
Prefix:
First Name:TASHEKA
Middle Name:JANAY
Last Name:HARRIS
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 1:703 FM 1385 APT 1307
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8157
Mailing Address - Country:US
Mailing Address - Phone:346-293-6466
Mailing Address - Fax:
Practice Address - Street 1:12021 DALLAS PKWY STE 132
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-3677
Practice Address - Country:US
Practice Address - Phone:346-293-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16532091744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management