Provider Demographics
NPI:1346598950
Name:BOROGERDI, TAYYEBEH NAHID (FNP)
Entity Type:Individual
Prefix:
First Name:TAYYEBEH
Middle Name:NAHID
Last Name:BOROGERDI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RIDGEHAVEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850
Mailing Address - Country:US
Mailing Address - Phone:607-786-4822
Mailing Address - Fax:
Practice Address - Street 1:3101 SHIPPERS RD
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2080
Practice Address - Country:US
Practice Address - Phone:607-786-4822
Practice Address - Fax:607-251-2010
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0337552363LW0102X
NY337552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health