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:GOVANS
Practice Address - State:MD
Practice Address - Zip Code:21212-3098
Practice Address - Country:US
Practice Address - Phone:443-466-7500
Practice Address - Fax:443-466-7500
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184543102L00000X, 207LP2900X, 207P00000X, 207RA0401X, 2083A0300X, 2083B0002X, 2083T0002X, 2084A0401X, 208D00000X, 208M00000X, 208VP0014X, 364SP0808X, 363LP0808X
MD174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No174H00000XOther Service ProvidersHealth Educator
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2083T0002XAllopathic & Osteopathic PhysiciansPreventive MedicineMedical Toxicology
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health