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General NPI Number Information
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NPI Number | 1508703943
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Entity Type | Individual
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Provider Name | TAHLEEF YASMEEN FITZGERALD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 108 E NORMAN AVE APT 4
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City | DAYTON
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State | OH
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Zip | 45405-3513
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Country | US
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Telephone | 614-207-2419
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Fax |
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Provider Business Mailing Address
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Address Line | 108 E NORMAN AVE APT 4
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City | DAYTON
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State | OH
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Zip | 45405-3513
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Country | US
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Telephone | 614-207-2419
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | PRS.007730
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License Number State | OH
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