Provider Demographics
NPI:1427201987
Name:SMITH, TANYA DOREEN (CNM)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:DOREEN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:DOREEN
Other - Last Name:MAGEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 STANAVAGE RD
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2033
Mailing Address - Country:US
Mailing Address - Phone:860-367-2691
Mailing Address - Fax:860-600-9885
Practice Address - Street 1:220 STANAVAGE RD
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-2033
Practice Address - Country:US
Practice Address - Phone:860-367-2691
Practice Address - Fax:860-600-9885
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2025-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000327367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife