Provider Demographics
NPI:1184391518
Name:TAMBA, CECELIA SIAH (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:SIAH
Last Name:TAMBA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 MEADOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2236
Mailing Address - Country:US
Mailing Address - Phone:240-354-3205
Mailing Address - Fax:888-919-4634
Practice Address - Street 1:3406 MEADOWDALE DR
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2236
Practice Address - Country:US
Practice Address - Phone:667-678-1048
Practice Address - Fax:888-919-4634
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2021039752363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD$$$$$$$$$OtherSOCIAL SECURITY OFFICE