Provider Demographics
NPI:1184345464
Name:ELLIS, RASHAYA TIARA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:RASHAYA
Middle Name:TIARA
Last Name:ELLIS
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94B STONE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2577
Mailing Address - Country:US
Mailing Address - Phone:203-993-3650
Mailing Address - Fax:
Practice Address - Street 1:94B STONE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2577
Practice Address - Country:US
Practice Address - Phone:203-583-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP4HG2D4246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy