Healthcare Provider Details

I. General information

NPI: 1063330710
Provider Name (Legal Business Name): TANYA YAJNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 BROADWAY
NEW YORK NY
10001-4483
US

IV. Provider business mailing address

173 RIVERSIDE DR APT 3C
NEW YORK NY
10024-1615
US

V. Phone/Fax

Practice location:
  • Phone: 929-656-4720
  • Fax:
Mailing address:
  • Phone: 972-743-4314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P144328-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: