Provider Demographics
NPI:1851312193
Name:CRENSHAW, TOSHEEN SABA (PA-C)
Entity Type:Individual
Prefix:
First Name:TOSHEEN
Middle Name:SABA
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BLYTHE BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5874
Mailing Address - Country:US
Mailing Address - Phone:704-344-5100
Mailing Address - Fax:704-342-4354
Practice Address - Street 1:1001 BLYTHE BLVD
Practice Address - Street 2:STE 500
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5874
Practice Address - Country:US
Practice Address - Phone:704-344-5100
Practice Address - Fax:704-342-4354
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103642207R00000X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D93596Medicare UPIN
2757416AMedicare ID - Type Unspecified