Healthcare Provider Details

I. General information

NPI: 1033020383
Provider Name (Legal Business Name): TASHA GEDEON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 DOHERTY AVE
ELMONT NY
11003-3019
US

IV. Provider business mailing address

274 DOHERTY AVE
ELMONT NY
11003-3019
US

V. Phone/Fax

Practice location:
  • Phone: 917-586-4362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number763801-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: