Provider Demographics
NPI:1669542395
Name:SINGH, TATSIANA (PA-C)
Entity type:Individual
Prefix:
First Name:TATSIANA
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TATSIANA
Other - Middle Name:
Other - Last Name:CALOGERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5667 BISON LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8169
Mailing Address - Country:US
Mailing Address - Phone:630-388-1740
Mailing Address - Fax:
Practice Address - Street 1:824 LOWER DALLAS HWY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9368
Practice Address - Country:US
Practice Address - Phone:704-874-0200
Practice Address - Fax:704-874-0201
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00353363A00000X
VA0110006517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN227700OMedicare PIN
NCQ62428Medicare UPIN