Provider Demographics
NPI:1922553312
Name:NAKHABENKO, TATYANA (PA)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:NAKHABENKO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TATYANA
Other - Middle Name:
Other - Last Name:KALINCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:280 CHESTNUT STREET
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:413-794-1629
Practice Address - Street 1:2 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 309
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1270
Practice Address - Country:US
Practice Address - Phone:413-794-8020
Practice Address - Fax:413-794-2165
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1189363AS0400X
MAPA9527363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1189OtherPHYSICIAN ASSISTANT LICENSE