Provider Demographics
NPI:1689919839
Name:MISHIN, TATYANA (MS)
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:MISHIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:MISHYNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 TANAGER CT
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-8435
Mailing Address - Country:US
Mailing Address - Phone:347-341-3104
Mailing Address - Fax:862-264-2372
Practice Address - Street 1:47 TANAGER CT
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-8435
Practice Address - Country:US
Practice Address - Phone:347-341-3104
Practice Address - Fax:862-264-2372
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541801111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY541801111OtherNY STATE DEPARTMENT OF EDUCATION