Healthcare Provider Details

I. General information

NPI: 1043450265
Provider Name (Legal Business Name): TATYANA NEVELEVA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 02/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 FRENCH RD
ROCHESTER NY
14618-5244
US

IV. Provider business mailing address

685 FRENCH RD
ROCHESTER NY
14618-5244
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-0997
  • Fax:
Mailing address:
  • Phone: 585-244-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number611877
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: