Provider Demographics
NPI:1265293757
Name:FAVORS, TEKEISHA SHANIQUE
Entity type:Individual
Prefix:MS
First Name:TEKEISHA
Middle Name:SHANIQUE
Last Name:FAVORS
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 1:10515 FLATLANDS 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3019
Mailing Address - Country:US
Mailing Address - Phone:347-414-2895
Mailing Address - Fax:
Practice Address - Street 1:10515 FLATLANDS 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3019
Practice Address - Country:US
Practice Address - Phone:347-414-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist