Provider Demographics
NPI:1407722432
Name:CHANDLER, TIFFANY (CPRS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14701 NATIONAL HWY SW STE 5
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6574
Mailing Address - Country:US
Mailing Address - Phone:301-250-1402
Mailing Address - Fax:
Practice Address - Street 1:14701 NATIONAL HWY SW STE 5&6
Practice Address - Street 2:
Practice Address - City:LAVALE
Practice Address - State:MD
Practice Address - Zip Code:21502-6573
Practice Address - Country:US
Practice Address - Phone:301-250-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDPR1291175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist