Individual
FIDELIS Y TAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6802 RIDGE BLVD APT 1P, BROOKLYN, NY 11220-5845
(646) 881-0273
Mailing address
6802 RIDGE BLVD APT 1P, BROOKLYN, NY 11220-5845
(646) 881-0273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
NY
Other
Enumeration date
12/12/2022
Last updated
06/27/2024
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