Provider Demographics
NPI:1851971386
Name:AVILES, TYTESHA D
Entity Type:Individual
Prefix:
First Name:TYTESHA
Middle Name:D
Last Name:AVILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 OLD OTTERDALE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-6546
Mailing Address - Country:US
Mailing Address - Phone:804-482-9118
Mailing Address - Fax:
Practice Address - Street 1:7825 MIDLOTHIAN TPKE STE 119
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5247
Practice Address - Country:US
Practice Address - Phone:804-253-0190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator