Provider Demographics
NPI:1477078186
Name:TAYIM, ADE ELEHANAH
Entity Type:Individual
Prefix:
First Name:ADE
Middle Name:ELEHANAH
Last Name:TAYIM
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 1:1203 REDCRESTED CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7081
Mailing Address - Country:US
Mailing Address - Phone:301-683-4579
Mailing Address - Fax:
Practice Address - Street 1:1203 REDCRESTED CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7081
Practice Address - Country:US
Practice Address - Phone:301-683-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHHA12952374U00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374U00000XNursing Service Related ProvidersHome Health Aide