Provider Demographics
NPI:1407677164
Name:BASTON, NIASIA LASHAWNA
Entity type:Individual
Prefix:
First Name:NIASIA
Middle Name:LASHAWNA
Last Name:BASTON
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 1:14615 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-5401
Mailing Address - Country:US
Mailing Address - Phone:347-386-0920
Mailing Address - Fax:
Practice Address - Street 1:14615 LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-5401
Practice Address - Country:US
Practice Address - Phone:347-386-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY374J00000XOtherTHE NATIONAL UNIFORM CLAIM COMMITTEE