Provider Demographics
NPI:1972340024
Name:HEREFORD, TAHESHA
Entity type:Individual
Prefix:MRS
First Name:TAHESHA
Middle Name:
Last Name:HEREFORD
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 1:12714 CRENNELL AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-4526
Mailing Address - Country:US
Mailing Address - Phone:216-242-9687
Mailing Address - Fax:
Practice Address - Street 1:5311 NORTHFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-1135
Practice Address - Country:US
Practice Address - Phone:216-242-9687
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health