MEDICARE: TYNESHA L EUTSAY

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861119083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYNESHA L EUTSAY

Provider Business Mailing Address
First Line	:	1302 NW 81ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33147-5258
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 NE 155TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-5623
Country	:	US
Telephone Number	:	305-400-1589
Fax Number	:

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

Provider Enumeration Date	:	10/27/2022
Last Update Date	:	10/27/2022

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Directions to “ TYNESHA L EUTSAY ” Practice Location

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