MEDICARE: DR. TATYANA SEMENOVA M.D.

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	2084P0804X	Child & Adolescent Psychiatry Physician	259209	NY
2	2084P0800X	Psychiatry Physician	259209	NY

General Provider Information

NPI Number	:	1437431269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATYANA SEMENOVA M.D.

Provider Business Mailing Address
First Line	:	2258 84 STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214
Country	:	US
Telephone Number	:	347-277-9084
Fax Number	:	718-331-3387

Provider Business Practice Location Address
First Line	:	626 SHEEPSHEAD BAY RD STE 530
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3606
Country	:	US
Telephone Number	:	347-277-9084
Fax Number	:

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	09/17/2020

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