Provider Demographics
NPI:1881688091
Name:TIFFANY, NANCY AMANDA (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:AMANDA
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:ULSTER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12487-5129
Mailing Address - Country:US
Mailing Address - Phone:845-338-5689
Mailing Address - Fax:
Practice Address - Street 1:293 RIVER RD
Practice Address - Street 2:
Practice Address - City:ULSTER PARK
Practice Address - State:NY
Practice Address - Zip Code:12487-5129
Practice Address - Country:US
Practice Address - Phone:845-338-5689
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000752174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist