Provider Demographics
NPI:1568067080
Name:SAUNDERS, NYESHA
Entity Type:Individual
Prefix:
First Name:NYESHA
Middle Name:
Last Name:SAUNDERS
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 1:259 W JOHNSON ST APT B3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2541
Mailing Address - Country:US
Mailing Address - Phone:267-629-0473
Mailing Address - Fax:
Practice Address - Street 1:259 W JOHNSON ST APT B3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2541
Practice Address - Country:US
Practice Address - Phone:267-629-0473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037442600001Medicaid