Provider Demographics
NPI:1952048308
Name:MIDDLETON, TANISHA
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:MIDDLETON
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 1:2 BENJAMIN PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1639
Mailing Address - Country:US
Mailing Address - Phone:347-753-6787
Mailing Address - Fax:718-691-4878
Practice Address - Street 1:2 BENJAMIN PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1639
Practice Address - Country:US
Practice Address - Phone:347-753-6787
Practice Address - Fax:718-691-4878
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program