Provider Demographics
NPI:1467570978
Name:BARDAKJIAN, TANYA (MS, CGC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:
Last Name:BARDAKJIAN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MARTINS RUN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1026
Mailing Address - Country:US
Mailing Address - Phone:610-325-8551
Mailing Address - Fax:215-456-2356
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:LEVY 2 WEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-8722
Practice Address - Fax:215-456-2356
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS