Healthcare Provider Details

I. General information

NPI: 1609043835
Provider Name (Legal Business Name): TATYANA SHERESHEVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

IV. Provider business mailing address

2205 W LINCOLN AVE
YAKIMA WA
98902-2437
US

V. Phone/Fax

Practice location:
  • Phone: 509-469-6305
  • Fax: 509-575-3395
Mailing address:
  • Phone: 509-469-6305
  • Fax: 509-575-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number51975-20
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC136085
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberC136085
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD61116194
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: