Provider Demographics
NPI:1881423499
Name:ISOM, TIFFANY SHALONDA
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:SHALONDA
Last Name:ISOM
Suffix:
Gender:F
Credentials:
Other - Prefix:PROF
Other - First Name:TIFFANY
Other - Middle Name:SHALONDA
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 MADISON AVE STE 605
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:567-312-8700
Mailing Address - Fax:
Practice Address - Street 1:500 MADISON AVE STE 605
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-1241
Practice Address - Country:US
Practice Address - Phone:567-312-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator