MEDICARE: TANYA TRUDEAU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1134059553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA TRUDEAU

Provider Business Mailing Address
First Line	:	82 SHERMAN ST APT C
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-4137
Country	:	US
Telephone Number	:	860-754-0398
Fax Number	:

Provider Business Practice Location Address
First Line	:	113 SALEM TPKE STE 200
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-6484
Country	:	US
Telephone Number	:	860-754-0398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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Directions to “ TANYA TRUDEAU ” Practice Location

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