Provider Demographics
NPI:1669250353
Name:DOLES, TYEISHA
Entity type:Individual
Prefix:
First Name:TYEISHA
Middle Name:
Last Name:DOLES
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 1:12806 CAROLINA MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-9662
Mailing Address - Country:US
Mailing Address - Phone:240-274-6529
Mailing Address - Fax:
Practice Address - Street 1:1100 EASTERN AVE NE APT 311
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4044
Practice Address - Country:US
Practice Address - Phone:202-270-4519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant