Healthcare Provider Details

I. General information

NPI: 1407228869
Provider Name (Legal Business Name): TATYANA MEZHEVICH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD YORK RD #101
WARMINSTER PA
18974-2013
US

IV. Provider business mailing address

1656 ROCKCRESS DR
JAMISON PA
18929-1645
US

V. Phone/Fax

Practice location:
  • Phone: 215-394-8625
  • Fax:
Mailing address:
  • Phone: 609-972-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS017944
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: