Provider Demographics
NPI:1841250396
Name:SIJ, TANYA (RNC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:SIJ
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 975341
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-0001
Mailing Address - Country:US
Mailing Address - Phone:972-791-1224
Mailing Address - Fax:972-819-0050
Practice Address - Street 1:874 ED HALL DR
Practice Address - Street 2:SUITE B-108
Practice Address - City:KAUFMAN
Practice Address - State:TX
Practice Address - Zip Code:75142-1861
Practice Address - Country:US
Practice Address - Phone:972-932-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRN624140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX500028581OtherMEDICARE RAILROAD
TX1736084-01Medicaid
TXP66018Medicare UPIN
TX500028581OtherMEDICARE RAILROAD