Provider Demographics
NPI:1376885962
Name:DOCKERY, TANYA ANN
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANN
Last Name:DOCKERY
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 1:626 N DIVISION ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2352
Mailing Address - Country:US
Mailing Address - Phone:914-373-8396
Mailing Address - Fax:
Practice Address - Street 1:626 N DIVISION ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2352
Practice Address - Country:US
Practice Address - Phone:914-373-8396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY286612-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse