=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144826041
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANNA R VAYON PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2020
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9180 PINECROFT DR STE 600
-----------------------------------------------------
City | SHENANDOAH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77380-3883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-296-0365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17183 INTERSTATE 45 SOUTH SUITE 530
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-230-4699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA14209
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------