Provider Demographics
NPI:1568214864
Name:RAY, TENEESHA MICHELLE
Entity Type:Individual
Prefix:
First Name:TENEESHA
Middle Name:MICHELLE
Last Name:RAY
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 1:2015 N 50TH ST UNIT 54
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4520
Mailing Address - Country:US
Mailing Address - Phone:480-957-5627
Mailing Address - Fax:
Practice Address - Street 1:4225 W GLENDALE AVE STE A200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8134
Practice Address - Country:US
Practice Address - Phone:480-957-5627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist