MEDICARE: TYNESHIA ALLEYNE LPN

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	164W00000X	Licensed Practical Nurse	0002047115	VA

General Provider Information

NPI Number	:	1598118960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYNESHIA ALLEYNE LPN

Provider Business Mailing Address
First Line	:	128 HAWKS NEST LN
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3272
Country	:	US
Telephone Number	:	757-672-7977
Fax Number	:

Provider Business Practice Location Address
First Line	:	5660 INDIAN RIVER RD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5240
Country	:	US
Telephone Number	:	757-366-5423
Fax Number	:

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	07/20/2016

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