Provider Demographics
NPI:1700578275
Name:TADESSE, ELENI
Entity Type:Individual
Prefix:
First Name:ELENI
Middle Name:
Last Name:TADESSE
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 1:8325 MEADOW RD APT 145
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3747
Mailing Address - Country:US
Mailing Address - Phone:469-749-7010
Mailing Address - Fax:
Practice Address - Street 1:8325 MEADOW RD APT 145
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3747
Practice Address - Country:US
Practice Address - Phone:469-749-7010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)