Provider Demographics
NPI:1811776545
Name:DIXON, MYEISHA C (BS)
Entity type:Individual
Prefix:
First Name:MYEISHA
Middle Name:C
Last Name:DIXON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 ARCH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2835
Mailing Address - Country:US
Mailing Address - Phone:267-940-5504
Mailing Address - Fax:215-558-6637
Practice Address - Street 1:3600 MARKET ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2669
Practice Address - Country:US
Practice Address - Phone:215-586-7615
Practice Address - Fax:215-660-0275
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator