Provider Information for 1366872707
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TARALEE LASHWAY
Sex: Female
NPI: 1366872707
Last Updated: 2024-10-04
Certification Date: 2024-10-01
Certification Date: 2024-10-01
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1366872707 | ||||||||||||
| Enumeration Date | 2013-11-21 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | P36 FIRST STREET W FORT DRUM, NY 13602-2603 United States Phone: 315-772-3778 | Fax: | ||||||||||||
| Primary Practice Address | 11050 MT BELVEDERE BLVD FORT DRUM, NY 13602-2603 United States Phone: 315-772-3778 | Fax: | ||||||||||||
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