Provider Demographics
NPI:1518759901
Name:WADE, TANYAH MARIA
Entity type:Individual
Prefix:
First Name:TANYAH
Middle Name:MARIA
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6011 GOODFELLOW DR
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3712
Mailing Address - Country:US
Mailing Address - Phone:443-254-3572
Mailing Address - Fax:
Practice Address - Street 1:1827 MARION BARRY AVE SE APT A12
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4664
Practice Address - Country:US
Practice Address - Phone:202-845-1411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant