Provider Demographics
NPI:1003151598
Name:TYNEBOR, DIANE ELIZABETH (TEACHER/VI)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:ELIZABETH
Last Name:TYNEBOR
Suffix:
Gender:F
Credentials:TEACHER/VI
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:SCHONNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 RACCOON PATH
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2142
Mailing Address - Country:US
Mailing Address - Phone:631-331-3517
Mailing Address - Fax:
Practice Address - Street 1:11 RACCOON PATH
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2142
Practice Address - Country:US
Practice Address - Phone:631-331-3517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
NY519395931174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$-AOtherMEDICARE HEALTH INSURANCE