Healthcare Provider Details

I. General information

NPI: 1497403372
Provider Name (Legal Business Name): TIANA M D'ACCHIOLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 ALEXANDER BELL DR STE 200
COLUMBIA MD
21046-2105
US

IV. Provider business mailing address

7208 DONNELL PL APT D1
FORESTVILLE MD
20747-4224
US

V. Phone/Fax

Practice location:
  • Phone: 410-705-0227
  • Fax: 646-859-4440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-182683
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: