Provider Demographics
NPI:1538552054
Name:TATNINOV, SONIA DEECHYN (LMT)
Entity type:Individual
Prefix:MS
First Name:SONIA
Middle Name:DEECHYN
Last Name:TATNINOV
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JAY ST
Mailing Address - Street 2:20F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1546
Mailing Address - Country:US
Mailing Address - Phone:917-561-2379
Mailing Address - Fax:
Practice Address - Street 1:100 JAY ST
Practice Address - Street 2:20F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1546
Practice Address - Country:US
Practice Address - Phone:917-561-2379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0255561225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist