Provider Demographics
NPI:1346717204
Name:PATTNAIK, TANAYA
Entity Type:Individual
Prefix:
First Name:TANAYA
Middle Name:
Last Name:PATTNAIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 RIPPLING WATER DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-6976
Mailing Address - Country:US
Mailing Address - Phone:530-219-3614
Mailing Address - Fax:
Practice Address - Street 1:8739 RIPPLING WATER DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-6976
Practice Address - Country:US
Practice Address - Phone:530-219-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-30
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program