Provider Demographics
NPI:1871324822
Name:HINSON, KEOSHA LASHAWNDRA
Entity type:Individual
Prefix:
First Name:KEOSHA
Middle Name:LASHAWNDRA
Last Name:HINSON
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 1:695 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-3162
Mailing Address - Country:US
Mailing Address - Phone:716-710-5151
Mailing Address - Fax:
Practice Address - Street 1:695 GENESEE ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14211-3162
Practice Address - Country:US
Practice Address - Phone:716-710-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist