MEDICARE: TASHANIYI BYRD CRNP-PMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R236777	MD

General Provider Information

NPI Number	:	1629890678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHANIYI BYRD CRNP-PMH

Provider Business Mailing Address
First Line	:	9456 BALLARD GREEN DR
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5913
Country	:	US
Telephone Number	:	443-994-6399
Fax Number	:

Provider Business Practice Location Address
First Line	:	7315 WISCONSIN AVE
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-3202
Country	:	US
Telephone Number	:	240-232-6146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2024
Last Update Date	:	06/16/2026

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