Provider Demographics
NPI:1396904611
Name:CHOICE, TANISHIA DESHA (MD)
Entity type:Individual
Prefix:
First Name:TANISHIA
Middle Name:DESHA
Last Name:CHOICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 381439
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02238-1439
Mailing Address - Country:US
Mailing Address - Phone:857-259-6679
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAWKEY CENTER FOR OUTPATIENT CARE, YAWKEY 6A
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-5600
Practice Address - Fax:617-724-5567
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN72412084P0800X
MA2506532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB127088Medicare PIN