Provider Demographics
NPI:1336741248
Name:FENELUS, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:FENELUS
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 1:53 E MERRICK RD # 141
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-4056
Mailing Address - Country:US
Mailing Address - Phone:407-725-6740
Mailing Address - Fax:
Practice Address - Street 1:53 E MERRICK RD # 141
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-4056
Practice Address - Country:US
Practice Address - Phone:407-725-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-15
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion