Provider Demographics
NPI:1558857136
Name:NDIAYE, MAKESHA (LPN)
Entity type:Individual
Prefix:
First Name:MAKESHA
Middle Name:
Last Name:NDIAYE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23834-5230
Mailing Address - Country:US
Mailing Address - Phone:804-605-7573
Mailing Address - Fax:
Practice Address - Street 1:3000 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23834-5230
Practice Address - Country:US
Practice Address - Phone:804-605-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002082768164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0002082700OtherNURSING