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General NPI Number Information
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NPI Number | 1073173696
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Entity Type | Individual
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Provider Name | TATIANNA CANADY
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Gender | Female
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 571 ONANCOCK TRL
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4367
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Country | US
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Telephone | 810-288-0221
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 TODDS LN # 301
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City | HAMPTON
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State | VA
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Zip | 23666-3123
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Country | US
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Telephone | 810-597-7141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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