Provider Demographics
NPI:1275785453
Name:WATERS, TANYA RENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:RENE
Last Name:WATERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:RENE
Other - Last Name:SHANKWEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1151 JORDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-5227
Mailing Address - Country:US
Mailing Address - Phone:484-547-6645
Mailing Address - Fax:
Practice Address - Street 1:807 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5223
Practice Address - Country:US
Practice Address - Phone:484-547-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-19
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016512103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical