Provider Demographics
NPI:1194150904
Name:LEE, TANECKA SHAREL
Entity type:Individual
Prefix:MRS
First Name:TANECKA
Middle Name:SHAREL
Last Name:LEE
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 1:1372 ANDRUS ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44301-1743
Mailing Address - Country:US
Mailing Address - Phone:330-475-5709
Mailing Address - Fax:
Practice Address - Street 1:1372 ANDRUS ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301-1743
Practice Address - Country:US
Practice Address - Phone:330-475-5709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant