Tecshana Nicola Blackwood, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

020717-1 Issued in NY

Practice address

1 Long Wharf Dr Ste 212
New Haven, CT 06511-5593

Phone

(203) 624-4208

Fax

(203) 624-4301

NPI assigned

Mar 31, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: tblackwood564492@nychhc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ag Urgent Care, P.C.

  • Urgent Care Clinic/Center
  • Brooklyn, NY
  • NPI 1992116701
  Medicare reassignment
• Kings Medical Family Practice PC

  • Family Medicine Physician
  • Brooklyn, NY
  • NPI 1316461387
  Medicare reassignment
• Samaritan Medical Services, P.C.

  • Internal Medicine Physician
  • West Islip, NY
  • NPI 1124184544
  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555977600000",
    "number": "1124550983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 W 39TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10018",
            "telephone_number": "347-523-1091",
            "fax_number": "203-624-4301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LONG WHARF DR STE 212",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115593",
            "telephone_number": "203-624-4208",
            "fax_number": "203-624-4301"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "86 Ridgely Ave",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CT",
            "postal_code": "06825",
            "country_code": "US",
            "telephone_number": "347-523-1091",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKWOOD",
        "first_name": "TECSHANA",
        "middle_name": "NICOLA",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-31",
        "last_updated": "2019-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146D00000X",
            "taxonomy_group": "",
            "desc": "Personal Emergency Response Attendant",
            "state": "NY",
            "license": "020717",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "0038009",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "3809",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "020717-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Black, MD
• Thomas C Black, APRN, MSN
• Holly Blackburn
• Leslie Ann Blackburn, D.D.S.
• Katherine Anne Blackwell
• Caitlin Blair
• Phillipa Blake, MSW
• Robert Tyler Blakes, MD, MBA
• Gregory George Blakley, LCSW
• Jermaine Blakley

• Physician Assistant in New Haven, CT
• Providers in New Haven, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.