Healthcare Provider Details

I. General information

NPI: 1336971704
Provider Name (Legal Business Name): TATIANA M VILAS BOAS CPPD, NICP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5719 63RD ST APT 2
MASPETH NY
11378-2812
US

IV. Provider business mailing address

5719 63RD ST APT 2
MASPETH NY
11378-2812
US

V. Phone/Fax

Practice location:
  • Phone: 914-382-0059
  • Fax:
Mailing address:
  • Phone: 914-382-0059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: