Healthcare Provider Details

I. General information

NPI: 1437890621
Provider Name (Legal Business Name): MISS TELAVIVE TAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 SOUTHWEST FWY STE 175
SUGAR LAND TX
77478-3892
US

IV. Provider business mailing address

PO BOX 20771
BELFAST ME
04915-4104
US

V. Phone/Fax

Practice location:
  • Phone: 346-646-3302
  • Fax: 713-461-5307
Mailing address:
  • Phone: 713-461-2915
  • Fax: 713-461-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberV9724
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: