Individual
TYASIA CHANTENIYA MOULTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19429 BRASSIE PL APT 301, MONTGOMERY VILLAGE, MD 20886-1938
(240) 789-8465
Mailing address
19429 BRASSIE PL APT 301, MONTGOMERY VILLAGE, MD 20886-1938
(240) 789-8465
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
07/16/2026
Last updated
07/16/2026
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