Provider Demographics
NPI:1063253532
Name:TEBO, SHANISE ABO
Entity type:Individual
Prefix:
First Name:SHANISE
Middle Name:ABO
Last Name:TEBO
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 1:12711 PROSPECT KNOLLS DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4606
Mailing Address - Country:US
Mailing Address - Phone:202-666-3684
Mailing Address - Fax:
Practice Address - Street 1:12711 PROSPECT KNOLLS DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4606
Practice Address - Country:US
Practice Address - Phone:202-666-3684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide