Healthcare Provider Details

I. General information

NPI: 1215868443
Provider Name (Legal Business Name): TYHISA SHANTE MCCRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 BENDERMERE AVE
OCEAN NJ
07712-4108
US

IV. Provider business mailing address

1112 BENDERMERE AVE
OCEAN NJ
07712-4108
US

V. Phone/Fax

Practice location:
  • Phone: 678-644-6903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: