Provider Demographics
NPI:1124805098
Name:DELVECCHIO, TAHARI SEPHORA (MRT)
Entity type:Individual
Prefix:MS
First Name:TAHARI
Middle Name:SEPHORA
Last Name:DELVECCHIO
Suffix:
Gender:F
Credentials:MRT
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Mailing Address - Street 1:11400 STATE HIGHWAY 30 STE 1102
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-7948
Mailing Address - Country:US
Mailing Address - Phone:979-485-5435
Mailing Address - Fax:949-695-3411
Practice Address - Street 1:11400 STATE HIGHWAY 30 STE 1102
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7948
Practice Address - Country:US
Practice Address - Phone:512-293-2000
Practice Address - Fax:949-695-3411
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-13
Last Update Date:2024-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX17582471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty