Provider Demographics
NPI:1205938040
Name:TSAI, NANCEY TREVANIAN (MD)
Entity type:Individual
Prefix:
First Name:NANCEY
Middle Name:TREVANIAN
Last Name:TSAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 N BASILICA AVE
Mailing Address - Street 2:
Mailing Address - City:HANAHAN
Mailing Address - State:SC
Mailing Address - Zip Code:29410-8657
Mailing Address - Country:US
Mailing Address - Phone:206-295-3621
Mailing Address - Fax:206-295-3621
Practice Address - Street 1:58 N BASILICA AVE
Practice Address - Street 2:
Practice Address - City:HANAHAN
Practice Address - State:SC
Practice Address - Zip Code:29410-8657
Practice Address - Country:US
Practice Address - Phone:206-295-3621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046856208100000X
SC23922208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00406260Medicare PIN
WAI66607Medicare UPIN
WA8862939Medicare PIN