Provider Demographics
NPI:1295593283
Name:LEE, TASHANNA RENEE
Entity type:Individual
Prefix:
First Name:TASHANNA
Middle Name:RENEE
Last Name:LEE
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 1:1119 CLEMENT AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3727
Mailing Address - Country:US
Mailing Address - Phone:937-701-3645
Mailing Address - Fax:
Practice Address - Street 1:1119 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3727
Practice Address - Country:US
Practice Address - Phone:937-701-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities