MEDICARE: TANYA WEATHERS

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	163W00000X	Registered Nurse	685458-1	NY

General Provider Information

NPI Number	:	1376950147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA WEATHERS

Provider Business Mailing Address
First Line	:	29 PEMBROOKE CT
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5012
Country	:	US
Telephone Number	:	631-553-3276
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 PEMBROKE COURT
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5013
Country	:	US
Telephone Number	:	631-553-3276
Fax Number	:

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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Directions to “ TANYA WEATHERS ” Practice Location

Language	Start Address	Practice Location

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