Healthcare Provider Details

I. General information

NPI: 1609402163
Provider Name (Legal Business Name): TANYA MEZHER MS, RD, CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BROADWAY
NEW YORK NY
10006-3008
US

IV. Provider business mailing address

1745 CATON AVE APT F1
BROOKLYN NY
11226-2737
US

V. Phone/Fax

Practice location:
  • Phone: 858-531-3704
  • Fax:
Mailing address:
  • Phone: 858-531-3704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86094738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: