Provider Demographics
NPI:1487909248
Name:BRAXTON, TAHSHEEMA LASHAWN
Entity type:Individual
Prefix:
First Name:TAHSHEEMA
Middle Name:LASHAWN
Last Name:BRAXTON
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 1:40 E SIDNEY AVE # SPT15D
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-1453
Mailing Address - Country:US
Mailing Address - Phone:914-609-7379
Mailing Address - Fax:
Practice Address - Street 1:40 E SIDNEY AVE # SPT15D
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1453
Practice Address - Country:US
Practice Address - Phone:914-609-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency