Healthcare Provider Details

I. General information

NPI: 1033635123
Provider Name (Legal Business Name): TASCHEA T REID RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 FLUSHING AVE FL 2
BROOKLYN NY
11206-5026
US

IV. Provider business mailing address

1112 LENOX RD
BROOKLYN NY
11212-2716
US

V. Phone/Fax

Practice location:
  • Phone: 718-828-2666
  • Fax:
Mailing address:
  • Phone: 347-455-4148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number722628
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: