Provider Demographics
NPI:1568278901
Name:BENSON, TYEISHA
Entity type:Individual
Prefix:MS
First Name:TYEISHA
Middle Name:
Last Name:BENSON
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 1:1437 FOREST VIEW DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-3203
Mailing Address - Country:US
Mailing Address - Phone:313-316-0826
Mailing Address - Fax:
Practice Address - Street 1:1437 FOREST VIEW DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-3203
Practice Address - Country:US
Practice Address - Phone:313-316-0826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide