Provider Demographics
NPI:1790351856
Name:CELEY, TYRONE II
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:
Last Name:CELEY
Suffix:II
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 1:1713 HOLBROOK ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2507
Mailing Address - Country:US
Mailing Address - Phone:202-441-7048
Mailing Address - Fax:
Practice Address - Street 1:1713 HOLBROOK ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2507
Practice Address - Country:US
Practice Address - Phone:202-441-7048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Single Specialty