Provider Demographics
NPI:1760377014
Name:WALLACE-FARQUHARSON, TANYA (PHD, MSN, RN)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:WALLACE-FARQUHARSON
Suffix:
Gender:F
Credentials:PHD, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 PLACE ONE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4810
Mailing Address - Country:US
Mailing Address - Phone:407-913-7815
Mailing Address - Fax:
Practice Address - Street 1:47 PLACE ONE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4810
Practice Address - Country:US
Practice Address - Phone:407-913-7815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY822138163WP0200X
DCRN500016296163WP0200X
DEL1-0074604163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics