Provider Demographics
NPI:1679750939
Name:MESH, TATYANA (NP)
Entity Type:Individual
Prefix:MS
First Name:TATYANA
Middle Name:
Last Name:MESH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545A CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2061
Mailing Address - Country:US
Mailing Address - Phone:617-522-5464
Mailing Address - Fax:617-522-0903
Practice Address - Street 1:545A CENTRE ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-2061
Practice Address - Country:US
Practice Address - Phone:617-522-5464
Practice Address - Fax:617-522-0903
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily