Provider Demographics
NPI:1992530687
Name:BURRELL, TAHIRA
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:
Last Name:BURRELL
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 CARRICK CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9970
Mailing Address - Country:US
Mailing Address - Phone:215-901-3203
Mailing Address - Fax:
Practice Address - Street 1:1412 N BOUVIER ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4215
Practice Address - Country:US
Practice Address - Phone:215-901-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No171M00000XOther Service ProvidersCase Manager/Care Coordinator