Provider Demographics
NPI:1508342817
Name:KADIRI, TYNISHA DIANE (PMHNP)
Entity type:Individual
Prefix:
First Name:TYNISHA
Middle Name:DIANE
Last Name:KADIRI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 ROLAND AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1352
Mailing Address - Country:US
Mailing Address - Phone:433-514-5775
Mailing Address - Fax:
Practice Address - Street 1:5900 YORK RD STE 202
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3098
Practice Address - Country:US
Practice Address - Phone:443-466-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184543363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health