Healthcare Provider Details

I. General information

NPI: 1336068808
Provider Name (Legal Business Name): TASHIRAH SADE SKINNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9505 REISTERSTOWN RD
OWINGS MILLS MD
21117-4451
US

IV. Provider business mailing address

226 S. CAROLINE ST APT 203
BALTIMORE MD
21231
US

V. Phone/Fax

Practice location:
  • Phone: 888-301-4065
  • Fax:
Mailing address:
  • Phone: 667-464-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberMD10276771396
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: