Provider Demographics
NPI:1366961518
Name:YELDER, CHANICE TIARA I (DO)
Entity type:Individual
Prefix:MS
First Name:CHANICE
Middle Name:TIARA
Last Name:YELDER
Suffix:I
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:CHANICE
Other - Middle Name:TIARA
Other - Last Name:YELDER
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1326 TRALEE CIR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2642
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1326 TRALEE CIR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2642
Practice Address - Country:UM
Practice Address - Phone:443-987-5907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDY-436115793640225500000X, 235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Single Specialty