Provider Demographics
NPI:1265327035
Name:DOMOND NDREU, TATIANA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:DOMOND NDREU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOUNDERS LAKE CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-7676
Mailing Address - Country:US
Mailing Address - Phone:803-477-5702
Mailing Address - Fax:
Practice Address - Street 1:10 FOUNDERS LAKE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-7676
Practice Address - Country:US
Practice Address - Phone:803-477-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist