Provider Demographics
NPI:1508342817
Name:KADIRI, TYNISHA DIANE (PMHNP)
Entity Type:Individual
Prefix:
First Name:TYNISHA
Middle Name:DIANE
Last Name:KADIRI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 ROLAND AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1352
Mailing Address - Country:US
Mailing Address - Phone:433-514-5775
Mailing Address - Fax:
Practice Address - Street 1:9807 DAVISON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-3892
Practice Address - Country:US
Practice Address - Phone:443-514-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program