Individual
MRS. TECSHANA NICOLA BLACKWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 LONG WHARF DR STE 212, NEW HAVEN, CT 06511-5593
(203) 624-4208
(203) 624-4301
Mailing address
55 W 39TH STREET, NEW YORK, NY 10018
(347) 523-1091
(203) 624-4301
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
020717
NY
363A00000X
Physician Assistant
0038009
CT
363A00000X
Physician Assistant
Primary
020717-1
NY
363AM0700X
Medical Physician Assistant
3809
CT
Other
Enumeration date
03/31/2017
Last updated
04/23/2019
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