Provider Demographics
NPI:1568128361
Name:CALLAHAN, MEKESHA
Entity Type:Individual
Prefix:
First Name:MEKESHA
Middle Name:
Last Name:CALLAHAN
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:PO BOX 1425
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33862-1425
Mailing Address - Country:US
Mailing Address - Phone:863-260-2084
Mailing Address - Fax:
Practice Address - Street 1:120 WILLIAMS AVE BLDG 1
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9411
Practice Address - Country:US
Practice Address - Phone:863-260-2084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services