Provider Demographics
NPI:1316655657
Name:CALDWELL, TASHA (MSN, RN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 FIR ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4919
Mailing Address - Country:US
Mailing Address - Phone:917-826-2867
Mailing Address - Fax:
Practice Address - Street 1:231 FIR ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-4919
Practice Address - Country:US
Practice Address - Phone:917-826-2867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY577776291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory