Provider Demographics
NPI:1013503010
Name:POVILIUNAS, TATYANA (PMHNP)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:POVILIUNAS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 PLANK RD STE 108
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-2033
Mailing Address - Country:US
Mailing Address - Phone:646-244-6136
Mailing Address - Fax:
Practice Address - Street 1:634 PLANK RD STE 108
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-2033
Practice Address - Country:US
Practice Address - Phone:646-244-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF403011363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health