Provider Demographics
NPI:1073339800
Name:MCDANIEL, TYLER ALEXANDER
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:ALEXANDER
Last Name:MCDANIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BRYDEN RD APT 506
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2181
Mailing Address - Country:US
Mailing Address - Phone:513-313-3747
Mailing Address - Fax:
Practice Address - Street 1:2211 LAKE CLUB DR STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3204
Practice Address - Country:US
Practice Address - Phone:614-881-1083
Practice Address - Fax:614-515-2693
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker