Provider Demographics
NPI:1497204598
Name:WHITE, TANISHA SHARDA
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:SHARDA
Last Name:WHITE
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 1:1116 ADNER RD
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8015
Mailing Address - Country:US
Mailing Address - Phone:318-507-9236
Mailing Address - Fax:
Practice Address - Street 1:1116 ADNER RD
Practice Address - Street 2:
Practice Address - City:HAUGHTON
Practice Address - State:LA
Practice Address - Zip Code:71037-8015
Practice Address - Country:US
Practice Address - Phone:318-507-9236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health