Provider Demographics
NPI:1962175919
Name:BANKS, IMANI TASHELLE (LSA, CSA)
Entity type:Individual
Prefix:MS
First Name:IMANI
Middle Name:TASHELLE
Last Name:BANKS
Suffix:
Gender:F
Credentials:LSA, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 TOLEDO TER APT 442
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3264
Mailing Address - Country:US
Mailing Address - Phone:516-717-5901
Mailing Address - Fax:
Practice Address - Street 1:8116 ARLINGTON BLVD STE 183
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1002
Practice Address - Country:US
Practice Address - Phone:703-659-4557
Practice Address - Fax:703-205-9010
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA2000004246ZC0007X
VA0136000340246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant