Provider Demographics
NPI:1356608392
Name:DUSSIE, TASHINA ELIZABETH (DO)
Entity type:Individual
Prefix:MISS
First Name:TASHINA
Middle Name:ELIZABETH
Last Name:DUSSIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8016 87TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1916
Mailing Address - Country:US
Mailing Address - Phone:718-316-0701
Mailing Address - Fax:
Practice Address - Street 1:402 POTTER BLVD
Practice Address - Street 2:
Practice Address - City:BRIGHTWATERS
Practice Address - State:NY
Practice Address - Zip Code:11718-1830
Practice Address - Country:US
Practice Address - Phone:631-894-5600
Practice Address - Fax:631-894-5625
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-16
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299334207R00000X, 207RC0000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program