Provider Demographics
NPI:1700333887
Name:MACON, TEISHA MARIE (CSFA)
Entity Type:Individual
Prefix:MRS
First Name:TEISHA
Middle Name:MARIE
Last Name:MACON
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:MISS
Other - First Name:TEISHA
Other - Middle Name:MARIE
Other - Last Name:STANSBURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:4406 LEGENDS BAY DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77523-3516
Mailing Address - Country:US
Mailing Address - Phone:281-728-3796
Mailing Address - Fax:
Practice Address - Street 1:4406 LEGENDS BAY DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77523-3516
Practice Address - Country:US
Practice Address - Phone:281-728-3796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant