Provider Demographics
NPI:1063201309
Name:UPSHAW, KANISHA
Entity type:Individual
Prefix:
First Name:KANISHA
Middle Name:
Last Name:UPSHAW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16243 EDGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3967
Mailing Address - Country:US
Mailing Address - Phone:440-561-9010
Mailing Address - Fax:
Practice Address - Street 1:16243 EDGEWOOD CT
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3967
Practice Address - Country:US
Practice Address - Phone:440-561-9010
Practice Address - Fax:440-561-9010
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide