MEDICARE: TASHLEY KEISHA FONROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1063221166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHLEY KEISHA FONROSE

Provider Business Mailing Address
First Line	:	80 OLD STONE WAY APT 307
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-2539
Country	:	US
Telephone Number	:	857-544-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 OLD STONE WAY APT 307
Second Line	:
City	:	WEYMOUTH
State	:	MA
Zip	:	02189-2539
Country	:	US
Telephone Number	:	857-544-9698
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2025
Last Update Date	:	01/03/2025

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Directions to “ TASHLEY KEISHA FONROSE ” Practice Location

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