Provider Demographics
NPI:1831919687
Name:BURTON, TAHNISHA E
Entity type:Individual
Prefix:
First Name:TAHNISHA
Middle Name:E
Last Name:BURTON
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 1:178 CUMMINGS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-4044
Mailing Address - Country:US
Mailing Address - Phone:585-203-6066
Mailing Address - Fax:
Practice Address - Street 1:178 CUMMINGS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-4044
Practice Address - Country:US
Practice Address - Phone:585-203-6066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY277180164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical