Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Tara Deitrick

Individual provider Certified Registered Nurse Anesthetist · NPI 1497855704

Tara Deitrick is a Certified Registered Nurse Anesthetist (CRNA) in Mineola, New York. Qualified in 1980, 46 years ago. Practices with Endoscopy Center of Long Island LLC, a 21-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
46
Licensed in
NY
In the registry since
2006

Practice location Address checks out

259 1st St
Mineola, NY 11501-3957
Phone: (516) 741-0570
Fax: (516) 741-8276
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 9330 (NY)

Record details

NPI number1497855704
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedSeptember 25, 2006
Last updated in NPPESNovember 29, 2017
Mailing address17 Kenwood Rd, Garden City, NY 11530-3034

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 1980 (46 years in practice)
Group practice Endoscopy Center Of Long Island Llc — 21 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Mineola