Tyniko Victoria Burrison
Individual provider Active NPI Contractor · Greenville, SC
NPI 1679206189 · NPPES record last updated Jul 3, 2022
Key facts
- NPI
- 1679206189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 126 Walden Creek Way
Greenville, SC 29615-6711 - Phone
- (803) 454-5765
- NPI assigned
- Jul 3, 2022
- 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 |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
126 Walden Creek Way
Greenville, SC 29615-6711
Mailing address
126 Walden Creek Way
Greenville, SC 29615-6711
Phone (803) 454-5765
Other providers in Greenville, SC
- Cadyn Liam Burnside
- Dazzetter Young Burnside
- Jared Robert Burr
- Rebekah Ann Burr
- Katherine Burras
- Ashley Phillips Burriss
- Zachary Taylor Burroughs
- Lashonda Burt-Reeder
- Robert John Burth
- Boshuna Burton
All providers in Greenville, SC · Contractor in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2022. 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.