Healthcare Provider Details

I. General information

NPI: 1205213501
Provider Name (Legal Business Name): TARA MEHRAD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2015
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MARKET ST
YONKERS NY
10710-7616
US

IV. Provider business mailing address

100 WOODS RD
VALHALLA NY
10595-1530
US

V. Phone/Fax

Practice location:
  • Phone: 914-831-6850
  • Fax:
Mailing address:
  • Phone: 914-493-1939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number343516
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: