Provider Demographics
NPI:1720730997
Name:DENIS, TARYN MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:MARIE
Last Name:DENIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 GARRETSON AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-2926
Mailing Address - Country:US
Mailing Address - Phone:631-383-4520
Mailing Address - Fax:
Practice Address - Street 1:1037 FULTON ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-4700
Practice Address - Country:US
Practice Address - Phone:631-578-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant