Basic Information
Provider Information
NPI: 1083806830
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SYCHEVA
FirstName: TATYANA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 171 TOWN CENTER DR
Address2: SUITE MPS-6
City: ANNISTON
State: AL
PostalCode: 362054101
CountryCode: US
TelephoneNumber: 2568473369
FaxNumber: 2568473469
Practice Location
Address1: 1400 AFFLINK PL
Address2: SUITE 100
City: TUSCALOOSA
State: AL
PostalCode: 354062289
CountryCode: US
TelephoneNumber: 2053669740
FaxNumber: 2053449992
Other Information
ProviderEnumerationDate: 08/15/2007
LastUpdateDate: 06/11/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XMD.28303ALY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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