Provider Demographics
NPI:1841846391
Name:MYERS, TIARA SHANTEL
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:SHANTEL
Last Name:MYERS
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 1:2551 ENTERPRISE PL
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4953
Mailing Address - Country:US
Mailing Address - Phone:301-300-5065
Mailing Address - Fax:
Practice Address - Street 1:301 TINGEY ST SE APT 303
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4614
Practice Address - Country:US
Practice Address - Phone:202-569-0214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant