Provider Demographics
NPI:1710560164
Name:CHAMBLISS, TOMEKA LYNISE
Entity Type:Individual
Prefix:
First Name:TOMEKA
Middle Name:LYNISE
Last Name:CHAMBLISS
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 1:807 PEBBLE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-3348
Mailing Address - Country:US
Mailing Address - Phone:804-437-3519
Mailing Address - Fax:
Practice Address - Street 1:807 PEBBLE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-3348
Practice Address - Country:US
Practice Address - Phone:804-437-3519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management