Provider Demographics
NPI:1477298529
Name:VIERA, TANNYA GABRIELA (PA)
Entity Type:Individual
Prefix:
First Name:TANNYA
Middle Name:GABRIELA
Last Name:VIERA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 DEEPDALE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-4249
Mailing Address - Country:US
Mailing Address - Phone:631-682-7194
Mailing Address - Fax:
Practice Address - Street 1:68 DEEPDALE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4249
Practice Address - Country:US
Practice Address - Phone:631-682-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant