Provider Demographics
NPI:1184437543
Name:BESAW, TANYA (LMBT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BESAW
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 BEARS DEN WAY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-9602
Mailing Address - Country:US
Mailing Address - Phone:910-305-9076
Mailing Address - Fax:
Practice Address - Street 1:5555 WALDOS BEACH RD STE A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-5507
Practice Address - Country:US
Practice Address - Phone:910-818-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18260225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist