Healthcare Provider Details

I. General information

NPI: 1740113620
Provider Name (Legal Business Name): TIFFANY MINOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7505 GREENWAY CENTER DR
GREENBELT MD
20770-3507
US

IV. Provider business mailing address

12231 ELM FOREST CT UNIT I
CLARKSBURG MD
20871-3387
US

V. Phone/Fax

Practice location:
  • Phone: 301-306-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPR1371
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: