Active NPI
S Valencia Tyrell, CPC
- Prevention Professional
- Capitol Heights, MD
National Provider Identifier
1083118582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- 077348897
- Practice address
- 920 Capitol Heights Blvd
Suite #B
Capitol Heights, MD 20743 - Phone
- (240) 505-8960
- Fax
- (240) 505-8960
- NPI assigned
- Mar 20, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prevention Professional | 405300000X | 077348897 | MD | Primary |
Addresses
Primary practice location
920 Capitol Heights Blvd
Suite #B
Capitol Heights, MD 20743
Mailing address
920 Capitol Heights Blvd
Suite #B
Capitol Heights, MD 20743
Phone (240) 505-8960
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 462409305 | Other | MD | CIGNA, UHC, CAREFIRST, AETNA, MEDICAID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 077348897 | MD | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1521504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521504000000",
"number": "1083118582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "920 CAPITOL HEIGHTS BLVD",
"address_2": "SUITE #B",
"city": "CAPITOL HEIGHTS",
"state": "MD",
"postal_code": "20743",
"telephone_number": "240-505-8960",
"fax_number": "240-505-8960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 CAPITOL HEIGHTS BLVD",
"address_2": "SUITE #B",
"city": "CAPITOL HEIGHTS",
"state": "MD",
"postal_code": "20743",
"telephone_number": "240-505-8960",
"fax_number": "240-505-8960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYRELL",
"first_name": "S VALENCIA",
"credential": "CPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-03-20",
"last_updated": "2018-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "MD",
"license": "077348897",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA, UHC, CAREFIRST, AETNA, MEDICAID",
"identifier": "462409305",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Capitol Heights, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.