Provider Demographics
NPI:1356192942
Name:FRISTON, DEAIJAH ZHANYLAH
Entity type:Individual
Prefix:
First Name:DEAIJAH
Middle Name:ZHANYLAH
Last Name:FRISTON
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 1:8712 W FAIRY CHASM DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-1814
Mailing Address - Country:US
Mailing Address - Phone:262-232-4435
Mailing Address - Fax:
Practice Address - Street 1:8712 W FAIRY CHASM DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-1814
Practice Address - Country:US
Practice Address - Phone:262-232-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty