Provider Demographics
NPI:1518112812
Name:PEREZ, TANYA JADE (MSED)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:JADE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9627 MYRTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5905
Mailing Address - Country:US
Mailing Address - Phone:917-541-6199
Mailing Address - Fax:
Practice Address - Street 1:9627 MYRTLE CREEK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5905
Practice Address - Country:US
Practice Address - Phone:917-541-6199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist