Provider Demographics
NPI:1447809637
Name:BEASLEY, TEISHA
Entity type:Individual
Prefix:
First Name:TEISHA
Middle Name:
Last Name:BEASLEY
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 1:116 N FILLMORE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-2628
Mailing Address - Country:US
Mailing Address - Phone:703-599-5146
Mailing Address - Fax:
Practice Address - Street 1:116 N FILLMORE AVE
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-2628
Practice Address - Country:US
Practice Address - Phone:703-599-5146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide