Individual
TYISHA KENSHAWNA ST. SURIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2011 S 25TH ST STE 108, FORT PIERCE, FL 34947-4795
(561) 777-5156
Mailing address
1168 SW COLEMAN AVE, PORT SAINT LUCIE, FL 34953-1823
(561) 777-5156
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
10/30/2019
Last updated
10/30/2019
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