Provider Demographics
NPI:1770170698
Name:TASLI, ALISHA H
Entity type:Individual
Prefix:MS
First Name:ALISHA
Middle Name:H
Last Name:TASLI
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 1:362 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1617
Mailing Address - Country:US
Mailing Address - Phone:631-806-3464
Mailing Address - Fax:
Practice Address - Street 1:362 DECATUR AVE
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1617
Practice Address - Country:US
Practice Address - Phone:631-806-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325853164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse