Healthcare Provider Details

I. General information

NPI: 1093161879
Provider Name (Legal Business Name): CECELIA TAYNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 05/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 GARRETT PARK RD
SILVER SPRING MD
20906-4829
US

IV. Provider business mailing address

4123 GARRETT PARK RD
SILVER SPRING MD
20906-4829
US

V. Phone/Fax

Practice location:
  • Phone: 301-828-7698
  • Fax:
Mailing address:
  • Phone: 301-828-7698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberR3885P
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: