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1376714139
TYESHA DOMINIQUE
NEW YORK, NY
NPI
1376714139
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: NY 012331)
Enumeration Date
2008-03-19
Last Update Date
2008-03-19
Business Address
Mrs. TYESHA DOMINIQUE
312 E 94TH ST
NEW YORK, NY 10128-5604
Phone number: 212-423-3000
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Mailing Address
Mrs. TYESHA DOMINIQUE
312 E 94TH ST
NEW YORK, NY 10128-5604
Phone number: 212-423-3000
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