Provider Demographics
NPI:1114596889
Name:OSILESI, TYRONE
Entity Type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:OSILESI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22648 GLENN DR STE 304
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20164-4448
Mailing Address - Country:US
Mailing Address - Phone:571-732-6800
Mailing Address - Fax:
Practice Address - Street 1:22648 GLENN DR STE 304
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-4448
Practice Address - Country:US
Practice Address - Phone:571-732-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 374U00000X
VA253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide