Provider Demographics
NPI:1669642237
Name:TYRELL, TAHIRAH A (MD)
Entity Type:Individual
Prefix:
First Name:TAHIRAH
Middle Name:A
Last Name:TYRELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TAHIRAH
Other - Middle Name:A
Other - Last Name:TYRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2304
Mailing Address - Country:US
Mailing Address - Phone:561-955-5365
Mailing Address - Fax:816-617-7717
Practice Address - Street 1:7305 N MILITARY TRL
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-7417
Practice Address - Country:US
Practice Address - Phone:561-955-5365
Practice Address - Fax:561-955-3577
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME115083390200000X, 207Q00000X
NY269460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program