Tyeisha M Boyd
Individual provider Active NPI Driver · Newark, NJ
NPI 1205683000 · NPPES record last updated May 1, 2024
Key facts
- NPI
- 1205683000
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 621 S 20TH St
Unit 2
Newark, NJ 07103 - Phone
- (862) 202-9909
- NPI assigned
- May 1, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | NJ | Yes |
Addresses
Primary practice location
621 S 20TH St
Unit 2
Newark, NJ 07103
Mailing address
621 S 20TH St
Unit 2
Newark, NJ 07103
Phone (862) 202-9909
Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.