Healthcare Provider Details

I. General information

NPI: 1821822628
Provider Name (Legal Business Name): TYRELLE ANDREWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 ROSIN CT
SACRAMENTO CA
95834-1656
US

IV. Provider business mailing address

3810 ROSIN CT
SACRAMENTO CA
95834-1656
US

V. Phone/Fax

Practice location:
  • Phone: 916-567-4222
  • Fax:
Mailing address:
  • Phone: 916-567-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-PLCWKY
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: