=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396661666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | T'YANNA SCUDDER MHC-LP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 RABRO DR
-----------------------------------------------------
City | HAUPPAUGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11788-4270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-257-5900
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 ELM ST
-----------------------------------------------------
City | CENTRAL ISLIP
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11722-4146
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | P134430
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------