Provider Demographics
NPI:1306386032
Name:COLEMAN-OBBY, TANYA
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:COLEMAN-OBBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-1009
Mailing Address - Country:US
Mailing Address - Phone:718-533-1013
Mailing Address - Fax:718-533-1083
Practice Address - Street 1:9901 34TH AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-1009
Practice Address - Country:US
Practice Address - Phone:718-533-1013
Practice Address - Fax:718-533-1083
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021207235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist