Healthcare Provider Details

I. General information

NPI: 1750209904
Provider Name (Legal Business Name): TATYANA PHEAREA TUY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 PEARSALL AVE STE 1
CEDARHURST NY
11516-1800
US

IV. Provider business mailing address

1109 HUDSON RD
SAINT PAUL MN
55106-6107
US

V. Phone/Fax

Practice location:
  • Phone: 516-371-1818
  • Fax:
Mailing address:
  • Phone: 516-371-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: