Provider Demographics
NPI:1235153875
Name:OPPENHEIMER, TANYA ANDREA (PSYD)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:ANDREA
Last Name:OPPENHEIMER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3308 W DEWEY ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-1517
Mailing Address - Country:US
Mailing Address - Phone:813-966-8456
Mailing Address - Fax:813-873-7650
Practice Address - Street 1:3308 W DEWEY ST
Practice Address - Street 2:MOBILE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1517
Practice Address - Country:US
Practice Address - Phone:813-966-8456
Practice Address - Fax:813-873-7650
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6879103T00000X
CA18942103T00000X
NY16748103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist