Provider Demographics
NPI:1871268391
Name:DASH, MAKEDA
Entity Type:Individual
Prefix:
First Name:MAKEDA
Middle Name:
Last Name:DASH
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 1:17010 130TH AVE APT 8E
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3251
Mailing Address - Country:US
Mailing Address - Phone:917-843-8181
Mailing Address - Fax:
Practice Address - Street 1:17010 130TH AVE APT 8E
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3251
Practice Address - Country:US
Practice Address - Phone:917-843-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA