Provider Demographics
NPI:1194981324
Name:KENNEDY, TATYANA (AU D, CCC-A)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:AU D, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 WHITE PLAINS ROAD-ENTA
Mailing Address - Street 2:SUITE 615
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-6802
Mailing Address - Country:US
Mailing Address - Phone:201-883-1062
Mailing Address - Fax:
Practice Address - Street 1:433 HACKENSACK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6319
Practice Address - Country:US
Practice Address - Phone:201-883-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002206231H00000X
NJ41YA00095000231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist