Healthcare Provider Details

I. General information

NPI: 1083451207
Provider Name (Legal Business Name): TYNISHA TAMARA POLLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 MONTEBELLO TER
BALTIMORE MD
21214-3311
US

IV. Provider business mailing address

7705 DANIELS AVE
BALTIMORE MD
21234-6913
US

V. Phone/Fax

Practice location:
  • Phone: 443-939-0121
  • Fax:
Mailing address:
  • Phone: 667-381-8556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: