Provider Demographics
NPI:1891553343
Name:MILLER, TAYEDIA SHANICE
Entity Type:Individual
Prefix:MS
First Name:TAYEDIA
Middle Name:SHANICE
Last Name:MILLER
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 1:11801 CORRIDOR LN APT 202
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7904
Mailing Address - Country:US
Mailing Address - Phone:646-533-5385
Mailing Address - Fax:
Practice Address - Street 1:11801 CORRIDOR LN APT 202
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-7904
Practice Address - Country:US
Practice Address - Phone:646-533-5385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty