Healthcare Provider Details

I. General information

NPI: 1396560777
Provider Name (Legal Business Name): MAIYSHA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 YEW RD
CHELTENHAM PA
19012-1218
US

IV. Provider business mailing address

111 YEW RD
CHELTENHAM PA
19012-1218
US

V. Phone/Fax

Practice location:
  • Phone: 215-454-0092
  • Fax:
Mailing address:
  • Phone: 215-454-0092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: