Healthcare Provider Details

I. General information

NPI: 1235079930
Provider Name (Legal Business Name): FENITA TAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HEALTH SCIENCES TOWER 16-020
STONY BROOK NY
11794-8160
US

IV. Provider business mailing address

HEALTH SCIENCES TOWER 16-020
STONY BROOK NY
11794-8160
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4630
  • Fax:
Mailing address:
  • Phone: 631-444-4630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: