Healthcare Provider Details

I. General information

NPI: 1679493035
Provider Name (Legal Business Name): MRS. ADENA CHANTAY TUFTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 CYNWOOD DR
EASTON MD
21601-3876
US

IV. Provider business mailing address

22454 GLENBOW WAY
CLARKSBURG MD
20871-9482
US

V. Phone/Fax

Practice location:
  • Phone: 410-770-8910
  • Fax:
Mailing address:
  • Phone: 216-926-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR205580
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: