Healthcare Provider Details

I. General information

NPI: 1790351856
Provider Name (Legal Business Name): TYRONE CELEY II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2021
Last Update Date: 05/31/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 HOLBROOK ST NE
WASHINGTON DC
20002-2507
US

IV. Provider business mailing address

1713 HOLBROOK ST NE
WASHINGTON DC
20002-2507
US

V. Phone/Fax

Practice location:
  • Phone: 202-441-7048
  • Fax:
Mailing address:
  • Phone: 202-441-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: