Basic Information
| Provider Information | |||||||||
| NPI: | 1568970572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCAFEE | ||||||||
| FirstName: | TIASHA | ||||||||
| MiddleName: | SHONTAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6040 PUBLIC LANDING RD | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218632453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106321100 | ||||||||
| FaxNumber: | 4106325682 | ||||||||
| Practice Location | |||||||||
| Address1: | 424 W MARKET ST STE A | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218631268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106329230 | ||||||||
| FaxNumber: | 4106329239 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2018 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.