Teshanee Dara Douglas, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

280133-1 Issued in NY

Practice address

121-123 West 111TH Street
New York, NY 10026

Phone

(212) 678-4990

NPI assigned

Jun 21, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Create, Inc.

  • Substance Abuse Rehabilitation Facility
  • New York, NY
  • NPI 1154711612
  NPD

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1629647920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "760 E 160TH ST FL 2",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104567898",
            "telephone_number": "315-294-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121-123 WEST 111TH STREET",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "10026",
            "telephone_number": "212-678-4990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "TESHANEE",
        "middle_name": "DARA",
        "name_prefix": "Ms.",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "280133-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "awards",
            "affiliation": "Y",
            "affiliationName": "Create Inc",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2121 Matthews Ave Apt 4F",
            "city": "Bronx",
            "state": "NY",
            "country_code": "US",
            "postal_code": "104622020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Parker Hazzard Douglas
• Peter A Douglas, MSW
• Rebecca Christina Douglas, FNP
• Samuel Garrison Douglas, LCSW
• Samuel Reed Douglas, LCSW
• Tiffany Douglas
• Zachary Douglas
• Alexandra Frances Douglass, LMSW
• Claire L Douglass, PA-C
• Elijah Douglass, M.D.

• Licensed Practical Nurse in New York, NY
• Providers in New York, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.