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NPI Code Detail

MEDICARE: TIA SHARDAE AYO

MEDICARE: TIA SHARDAE AYO
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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
32355S0801XSpeech-Language Assistant42956TX

General Provider Information

NPI Number : 1841768744
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIA SHARDAE AYO
Provider Business Mailing Address
First Line : 12770 COIT RD STE 870
Second Line :
City : DALLAS
State : TX
Zip : 75251-1455
Country : US
Telephone Number : 972-756-0500
Fax Number : 972-765-0448
Provider Business Practice Location Address
First Line : 12770 COIT RD STE 870
Second Line :
City : DALLAS
State : TX
Zip : 75251-1455
Country : US
Telephone Number : 972-756-0500
Fax Number : 972-765-0448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2018
Last Update Date : 12/30/2022

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Directions to “ TIA SHARDAE AYO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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