Provider Demographics
NPI:1487391322
Name:TALIAFERRO, TRISSY LEE
Entity type:Individual
Prefix:MRS
First Name:TRISSY
Middle Name:LEE
Last Name:TALIAFERRO
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 1:1115 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-4541
Mailing Address - Country:US
Mailing Address - Phone:757-635-7380
Mailing Address - Fax:
Practice Address - Street 1:1115 GUTHRIE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-4541
Practice Address - Country:US
Practice Address - Phone:757-635-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT65518181343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)