Provider Demographics
NPI:1437956653
Name:KOON, TANESHIA LYNEA
Entity type:Individual
Prefix:MISS
First Name:TANESHIA
Middle Name:LYNEA
Last Name:KOON
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 1:1223 PAMELA ST APT 7
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3828
Mailing Address - Country:US
Mailing Address - Phone:321-444-9656
Mailing Address - Fax:
Practice Address - Street 1:1223 PAMELA ST APT 7
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3828
Practice Address - Country:US
Practice Address - Phone:321-444-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician