Provider Demographics
NPI:1972737922
Name:BUTTAR, TAYYBA G (MD)
Entity type:Individual
Prefix:DR
First Name:TAYYBA
Middle Name:G
Last Name:BUTTAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MEADOWLANDS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-6026
Mailing Address - Country:US
Mailing Address - Phone:704-214-1003
Mailing Address - Fax:
Practice Address - Street 1:3736 OLD VINEYARD RD
Practice Address - Street 2:OLD VINEYARD BEHAVIORAL HEALTH SERVICES
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27284
Practice Address - Country:US
Practice Address - Phone:336-794-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1839782084P0800X
MA2372992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry