Healthcare Provider Details

I. General information

NPI: 1174340426
Provider Name (Legal Business Name): TSADAE NEWAY CMT, FNLP, DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 MARTIN LUTHER KING JR WAY STE B
OAKLAND CA
94609-1836
US

IV. Provider business mailing address

504 W MERLE CT
SAN LEANDRO CA
94577-2041
US

V. Phone/Fax

Practice location:
  • Phone: 510-816-7247
  • Fax:
Mailing address:
  • Phone: 510-816-7247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number40882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: