Provider Demographics
NPI:1366083420
Name:DEMESSA, TANISHA NEKITA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:NEKITA
Last Name:DEMESSA
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4341
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20914-4341
Mailing Address - Country:US
Mailing Address - Phone:240-676-6830
Mailing Address - Fax:
Practice Address - Street 1:13244 MUSICMASTER DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6807
Practice Address - Country:US
Practice Address - Phone:240-676-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD224864246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty