Provider Demographics
NPI:1013800937
Name:MCCOY, TYISHUA NESHEEN
Entity type:Individual
Prefix:
First Name:TYISHUA
Middle Name:NESHEEN
Last Name:MCCOY
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 1:249 CENTRAL PARK AVE # 300-175
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3099
Mailing Address - Country:US
Mailing Address - Phone:757-375-9836
Mailing Address - Fax:
Practice Address - Street 1:2449 PRINCESS ANNE RD BLDG 2ND
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-9116
Practice Address - Country:US
Practice Address - Phone:757-375-9836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-30
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator