Provider Demographics
NPI:1831935006
Name:LEWIS, TASHEEKA MONA
Entity type:Individual
Prefix:
First Name:TASHEEKA
Middle Name:MONA
Last Name:LEWIS
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 1:21 SOJOURNER TRUTH CT
Mailing Address - Street 2:
Mailing Address - City:ROXBURY CROSSING
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2436
Mailing Address - Country:US
Mailing Address - Phone:857-445-6291
Mailing Address - Fax:
Practice Address - Street 1:21 SOJOURNER TRUTH CT
Practice Address - Street 2:
Practice Address - City:ROXBURY CROSSING
Practice Address - State:MA
Practice Address - Zip Code:02120-2436
Practice Address - Country:US
Practice Address - Phone:857-445-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9520038163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse