Provider Demographics
NPI:1396352829
Name:WILLIAMS, TYESHA BRITTANY (PBT,RCMA, ASCP)
Entity type:Individual
Prefix:MS
First Name:TYESHA
Middle Name:BRITTANY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PBT,RCMA, ASCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 LYNDHURST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1924
Mailing Address - Country:US
Mailing Address - Phone:443-535-3528
Mailing Address - Fax:
Practice Address - Street 1:1014 LYNDHURST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1924
Practice Address - Country:US
Practice Address - Phone:443-535-3528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18301551246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty