Provider Demographics
NPI:1205378338
Name:JONES, TANISHIA (MSED)
Entity type:Individual
Prefix:MS
First Name:TANISHIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 VANDALIA AVE
Mailing Address - Street 2:14B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1421
Mailing Address - Country:US
Mailing Address - Phone:347-528-5897
Mailing Address - Fax:
Practice Address - Street 1:3769 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2041
Practice Address - Country:US
Practice Address - Phone:718-769-9888
Practice Address - Fax:718-769-1988
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator