Provider Demographics
NPI:1912551938
Name:MARSHALL, TANIA MONIQUE (MSC)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:MONIQUE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-2014
Mailing Address - Country:US
Mailing Address - Phone:646-271-7824
Mailing Address - Fax:
Practice Address - Street 1:340 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-2014
Practice Address - Country:US
Practice Address - Phone:646-271-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist