Provider Demographics
NPI:1780854091
Name:MCMILLION, TANESHIA FAYE (SLA)
Entity Type:Individual
Prefix:MRS
First Name:TANESHIA
Middle Name:FAYE
Last Name:MCMILLION
Suffix:
Gender:F
Credentials:SLA
Other - Prefix:MRS
Other - First Name:TANESHIA
Other - Middle Name:FAYE
Other - Last Name:BREDWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLA
Mailing Address - Street 1:7595 HAMPTON BLVD
Mailing Address - Street 2:
Mailing Address - City:N LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5586
Mailing Address - Country:US
Mailing Address - Phone:954-234-2350
Mailing Address - Fax:
Practice Address - Street 1:5576 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073-3423
Practice Address - Country:US
Practice Address - Phone:954-974-2977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI 13942355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSI 1394OtherSPEECH THERAPY ASSISTANT