Provider Demographics
NPI:1215500558
Name:WASHINGTON, NIASHANI L (HEALTH COACH)
Entity type:Individual
Prefix:
First Name:NIASHANI
Middle Name:L
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:HEALTH COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-1403
Mailing Address - Country:US
Mailing Address - Phone:866-719-9611
Mailing Address - Fax:901-284-2536
Practice Address - Street 1:139 N 4TH ST
Practice Address - Street 2:TELEMEDICINE
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837
Practice Address - Country:US
Practice Address - Phone:866-719-9611
Practice Address - Fax:901-284-2536
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227006085225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist