Healthcare Provider Details

I. General information

NPI: 1407751472
Provider Name (Legal Business Name): MS. TYLAH CHANTE MILO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

358 SUMMER AVE APT 2
NEWARK NJ
07104-2859
US

IV. Provider business mailing address

358 SUMMER AVE APT 2
NEWARK NJ
07104-2859
US

V. Phone/Fax

Practice location:
  • Phone: 646-331-3710
  • Fax:
Mailing address:
  • Phone: 646-331-3710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL07324900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: