Provider Demographics
NPI:1265313647
Name:DAVIS, TIESHA EVELYN (LPN)
Entity type:Individual
Prefix:MS
First Name:TIESHA
Middle Name:EVELYN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 W 147TH ST APT 4B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-3616
Mailing Address - Country:US
Mailing Address - Phone:212-683-6700
Mailing Address - Fax:212-683-6700
Practice Address - Street 1:298 W 147TH ST APT 4B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-3616
Practice Address - Country:US
Practice Address - Phone:212-683-6700
Practice Address - Fax:212-683-6700
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY345972164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty