Individual
TANYA R GRACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
2655 RIDGEWAY AVE, SUITE 420, ROCHESTER, NY 14626-4296
(585) 723-7972
(585) 368-3119
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553
(585) 922-0496
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
020255
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01662182
MEDICARE RR
NY
Enumeration date
10/15/2013
Last updated
10/18/2022
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