Provider Demographics
NPI:1639842552
Name:GEORGE, TANISHA SADE'
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:SADE'
Last Name:GEORGE
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 1:21031 WESTPORT AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2847
Mailing Address - Country:US
Mailing Address - Phone:216-512-4812
Mailing Address - Fax:
Practice Address - Street 1:21031 WESTPORT AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2847
Practice Address - Country:US
Practice Address - Phone:216-512-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health