Healthcare Provider Details

I. General information

NPI: 1609916113
Provider Name (Legal Business Name): TANYA ELSTON BURNETTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA KAY ELSTON PA.

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

772 N TOWNVILLE ST
SENECA SC
29678-2645
US

IV. Provider business mailing address

300 E MCBEE AVE STE 300
GREENVILLE SC
29601-2899
US

V. Phone/Fax

Practice location:
  • Phone: 864-886-9300
  • Fax: 864-886-9399
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003677
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number536
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number003677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: