Healthcare Provider Details

I. General information

NPI: 1316655145
Provider Name (Legal Business Name): TYE & CO BEAUTY BAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 PENNSYLVANIA AVE
BALTIMORE MD
21217-3234
US

IV. Provider business mailing address

2051 PENNSYLVANIA AVE
BALTIMORE MD
21217-3234
US

V. Phone/Fax

Practice location:
  • Phone: 410-353-0816
  • Fax:
Mailing address:
  • Phone: 410-353-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. TYSHIEKA BAILEY
Title or Position: HAIR LOSS SPECIALIST
Credential: MARYLAND
Phone: 410-353-0816