Organization
MYA NICHELLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMIYA WADE (OWNER)
(610) 809-8332
Entity
Organization
Contact information
Practice address
100 W BALTIMORE AVE APT H, LANSDOWNE, PA 19050-2139
(610) 809-8332
Mailing address
1626 LOCUST ST, PHILADELPHIA, PA 19103-6305
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
01/11/2022
Last updated
01/11/2022
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