Provider Demographics
NPI:1215742531
Name:MILES, TYRONESHA T (BPD)
Entity type:Individual
Prefix:
First Name:TYRONESHA
Middle Name:T
Last Name:MILES
Suffix:
Gender:F
Credentials:BPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WASHINGTON AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-3809
Mailing Address - Country:US
Mailing Address - Phone:475-225-6295
Mailing Address - Fax:
Practice Address - Street 1:210 WASHINGTON AVE APT 109
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-3809
Practice Address - Country:US
Practice Address - Phone:860-344-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTTT112887374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula