Provider Demographics
NPI:1386332633
Name:SPIVEY, TASHA M
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:M
Last Name:SPIVEY
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 1:1260 WHITE ST # 2
Mailing Address - Street 2:
Mailing Address - City:HILLSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07205-2219
Mailing Address - Country:US
Mailing Address - Phone:862-214-1347
Mailing Address - Fax:
Practice Address - Street 1:1260 WHITE ST # 2
Practice Address - Street 2:
Practice Address - City:HILLSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07205-2219
Practice Address - Country:US
Practice Address - Phone:862-214-1347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor