Provider Demographics
NPI:1023846078
Name:CAMPBELL, TISHAWNA
Entity type:Individual
Prefix:
First Name:TISHAWNA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 HUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5626
Mailing Address - Country:US
Mailing Address - Phone:718-564-9444
Mailing Address - Fax:
Practice Address - Street 1:2420 HUNTER AVE APT 11A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5634
Practice Address - Country:US
Practice Address - Phone:718-564-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist