Provider Demographics
NPI:1295095792
Name:WALDEN, TAKIYAH PATRICIA
Entity type:Individual
Prefix:
First Name:TAKIYAH
Middle Name:PATRICIA
Last Name:WALDEN
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 1:1155 PENNSYLVANIA AVE APT 19E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1204
Mailing Address - Country:US
Mailing Address - Phone:347-538-0222
Mailing Address - Fax:
Practice Address - Street 1:1155 PENNSYLVANIA AVE APT 19E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-1204
Practice Address - Country:US
Practice Address - Phone:347-538-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator