Healthcare Provider Details

I. General information

NPI: 1477206209
Provider Name (Legal Business Name): TANYA L FABIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2134
US

IV. Provider business mailing address

290 LITTLETON RD UNIT 3
CHELMSFORD MA
01824-3429
US

V. Phone/Fax

Practice location:
  • Phone: 978-937-6439
  • Fax:
Mailing address:
  • Phone: 978-258-4734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN212437
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: