Healthcare Provider Details

I. General information

NPI: 1003618737
Provider Name (Legal Business Name): SOPHY TEMBIEU TANYI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13905 BRIARWOOD DR APT 533
LAUREL MD
20708-1340
US

IV. Provider business mailing address

13905 BRIARWOOD DR APT 533
LAUREL MD
20708-1340
US

V. Phone/Fax

Practice location:
  • Phone: 757-502-9614
  • Fax:
Mailing address:
  • Phone: 757-502-9614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: