Provider Demographics
NPI:1235961145
Name:BYRD NEELEY, TONYA
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:BYRD NEELEY
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 1:2908 175TH ST
Mailing Address - Street 2:
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-1706
Mailing Address - Country:US
Mailing Address - Phone:708-295-4228
Mailing Address - Fax:
Practice Address - Street 1:2908 175TH ST
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1706
Practice Address - Country:US
Practice Address - Phone:708-295-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle