Provider Demographics
NPI:1427286178
Name:TALAVERA, TYSHA-MONIQUE HELEN (LMT)
Entity type:Individual
Prefix:MRS
First Name:TYSHA-MONIQUE
Middle Name:HELEN
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 S REYNOLDS ST
Mailing Address - Street 2:APT.206
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4400
Mailing Address - Country:US
Mailing Address - Phone:347-622-6678
Mailing Address - Fax:
Practice Address - Street 1:6910 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-1849
Practice Address - Country:US
Practice Address - Phone:571-357-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019007162172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker