Provider Demographics
NPI:1669830949
Name:TYSINGER, CHRISTINA RUBY
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RUBY
Last Name:TYSINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:RUBY
Other - Last Name:PHELPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1331 ROCK CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2036
Mailing Address - Country:US
Mailing Address - Phone:970-217-4432
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST STE 200
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4739
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:718-886-8694
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist