Provider Demographics
NPI:1356190763
Name:MASTRIANO, TATIANA SOPHIA (OD)
Entity type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:SOPHIA
Last Name:MASTRIANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 SW CIMARRON CT
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-5743
Mailing Address - Country:US
Mailing Address - Phone:954-668-5811
Mailing Address - Fax:
Practice Address - Street 1:2660 SW IMMANUEL DR
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2738
Practice Address - Country:US
Practice Address - Phone:772-283-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program