Healthcare Provider Details

I. General information

NPI: 1356259196
Provider Name (Legal Business Name): TASSCIA WOMEN'S HEALTH & COSMETIC GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 W NEW HAVEN AVE
MELBOURNE FL
32904-3705
US

IV. Provider business mailing address

2795 W NEW HAVEN AVE
MELBOURNE FL
32904-3705
US

V. Phone/Fax

Practice location:
  • Phone: 516-662-2617
  • Fax:
Mailing address:
  • Phone: 516-662-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TASSCIA WILLIAMS-SOUFFRANT
Title or Position: OWNER/PHYSICIAN
Credential: MD, MPH
Phone: 516-662-2617