Healthcare Provider Details

I. General information

NPI: 1568302768
Provider Name (Legal Business Name): TYNAISHA ZAMBRANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E 149TH ST RM 500
BRONX NY
10451-5603
US

IV. Provider business mailing address

349 E 149TH ST RM 500
BRONX NY
10451-5603
US

V. Phone/Fax

Practice location:
  • Phone: 706-715-9486
  • Fax:
Mailing address:
  • Phone: 706-715-9486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115645-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: