Provider Demographics
NPI:1730513631
Name:MCLEAN, TASHA (NP)
Entity type:Individual
Prefix:MISS
First Name:TASHA
Middle Name:
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 TOWN GREEN DR BLDG 5
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2322
Mailing Address - Country:US
Mailing Address - Phone:914-207-3672
Mailing Address - Fax:
Practice Address - Street 1:54 TOWN GREEN DR BLDG 5
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-2322
Practice Address - Country:US
Practice Address - Phone:914-207-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582984163W00000X, 163WI0500X, 163WW0000X
NYF343497-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WW0000XNursing Service ProvidersRegistered NurseWound Care