Provider Demographics
NPI:1710330667
Name:DARISAW, LASHAYA DENISE (BAS)
Entity Type:Individual
Prefix:MS
First Name:LASHAYA
Middle Name:DENISE
Last Name:DARISAW
Suffix:
Gender:F
Credentials:BAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 SUFFOLK CT
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-3115
Mailing Address - Country:US
Mailing Address - Phone:810-394-9515
Mailing Address - Fax:
Practice Address - Street 1:3611 SUFFOLK CT
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-3115
Practice Address - Country:US
Practice Address - Phone:810-394-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other