Provider Demographics
NPI:1083096432
Name:HENDERSON, TASIA (DNP)
Entity type:Individual
Prefix:DR
First Name:TASIA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 S BROADWAY STE 207
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1845
Mailing Address - Country:US
Mailing Address - Phone:914-200-4368
Mailing Address - Fax:914-226-3251
Practice Address - Street 1:180 S BROADWAY STE 207
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1845
Practice Address - Country:US
Practice Address - Phone:845-690-0058
Practice Address - Fax:401-287-8847
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2276358363LP0808X
RIAPRN00690363LF0000X
NY403452363LP0808X
NJ26NJ15137100363LP0808X
CT13119363LP0808X
RIAPRN02587363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily