Healthcare Provider Details

I. General information

NPI: 1669346151
Provider Name (Legal Business Name): TYSHAWN EASON
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N FRANKLIN ST
HEMPSTEAD NY
11550-1318
US

IV. Provider business mailing address

135 E SEAMAN AVE
FREEPORT NY
11520-1625
US

V. Phone/Fax

Practice location:
  • Phone: 516-746-0350
  • Fax:
Mailing address:
  • Phone: 516-746-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: