Individual
TETYANA L VASYLYEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD
Contact information
Practice address
1400 S COULTER ST, AMARILLO, TX 79106-1786
(806) 414-9800
(806) 354-5689
Mailing address
1400 WALLACE BLVD, AMARILLO, TX 79106-1708
(806) 414-9800
(806) 354-5689
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
228852
MA
2080P0210X
Pediatric Nephrology Physician
234150
MA
2080P0210X
Pediatric Nephrology Physician
42535
TX
2080P0210X
Pediatric Nephrology Physician
Primary
N8070
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198943601
—
TX
05
—
198943602
—
TX
05
—
200232360A
—
OK
05
—
73730785
—
NM
Enumeration date
05/24/2007
Last updated
11/10/2016
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