Provider Demographics
NPI:1881373942
Name:GOODWIN, TANEISHA
Entity type:Individual
Prefix:
First Name:TANEISHA
Middle Name:
Last Name:GOODWIN
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 1:26871 SHOREVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1536
Mailing Address - Country:US
Mailing Address - Phone:216-233-3818
Mailing Address - Fax:
Practice Address - Street 1:26871 SHOREVIEW AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1536
Practice Address - Country:US
Practice Address - Phone:216-233-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver