Provider Demographics
NPI:1851660070
Name:LYAMZINA, TANZELYA (LPN)
Entity Type:Individual
Prefix:MS
First Name:TANZELYA
Middle Name:
Last Name:LYAMZINA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 BROADWAY
Mailing Address - Street 2:2ND FL
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2707
Mailing Address - Country:US
Mailing Address - Phone:631-608-8523
Mailing Address - Fax:631-608-8527
Practice Address - Street 1:373 BROADWAY
Practice Address - Street 2:2ND FL
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2707
Practice Address - Country:US
Practice Address - Phone:631-608-8523
Practice Address - Fax:631-608-8527
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308455164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse