Provider Demographics
NPI:1194925065
Name:ELEY, TYWANDA J
Entity type:Individual
Prefix:MRS
First Name:TYWANDA
Middle Name:J
Last Name:ELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TYWANDA
Other - Middle Name:
Other - Last Name:ELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SIMPSON
Mailing Address - Street 1:1401 DENNIS AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3827
Mailing Address - Country:US
Mailing Address - Phone:240-286-6531
Mailing Address - Fax:
Practice Address - Street 1:1401 DENNIS AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-3827
Practice Address - Country:US
Practice Address - Phone:240-286-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-05-23
Deactivation Date:2010-07-28
Deactivation Code:
Reactivation Date:2019-07-24
Provider Licenses
StateLicense IDTaxonomies
MD05149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist