Healthcare Provider Details

I. General information

NPI: 1548100886
Provider Name (Legal Business Name): LAYLA MARIE TIBERIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2950
US

IV. Provider business mailing address

241 HARLEM RD
PASADENA MD
21122-2936
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-5304
  • Fax:
Mailing address:
  • Phone: 443-844-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: