Healthcare Provider Details

I. General information

NPI: 1356045769
Provider Name (Legal Business Name): TIFFANY ANDREA CASH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 SUMMERSWEET DR
CLINTON MD
20735-2634
US

IV. Provider business mailing address

6200 SUMMERSWEET DR
CLINTON MD
20735-2634
US

V. Phone/Fax

Practice location:
  • Phone: 202-486-7435
  • Fax:
Mailing address:
  • Phone: 202-486-7435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10273594375
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number10273594375
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: