Provider Demographics
NPI:1538538988
Name:TETTEH, DESIRE NUSIENYO
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:NUSIENYO
Last Name:TETTEH
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 1:685 E 240TH ST
Mailing Address - Street 2:APT.1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1526
Mailing Address - Country:US
Mailing Address - Phone:718-734-5102
Mailing Address - Fax:
Practice Address - Street 1:685 E 240TH ST
Practice Address - Street 2:APT.1
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1526
Practice Address - Country:US
Practice Address - Phone:718-734-5102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691942-1372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider