Provider Demographics
NPI:1952567034
Name:TAVERAS, DEYANIRIS RAMONA
Entity Type:Individual
Prefix:
First Name:DEYANIRIS
Middle Name:RAMONA
Last Name:TAVERAS
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 1:402 W TILGHMAN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2442
Mailing Address - Country:US
Mailing Address - Phone:484-221-8332
Mailing Address - Fax:610-351-8266
Practice Address - Street 1:402 W TILGHMAN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2442
Practice Address - Country:US
Practice Address - Phone:484-221-8332
Practice Address - Fax:610-351-8266
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist