Tara McDermott-Banta

Primary specialty

SpecialistTaxonomy code 174400000X

License

515741041 Issued in NY

Practice address

107 Hampton Blvd
Massapequa, NY 11758-7364

Phone

(516) 205-8822

NPI assigned

Jun 17, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649635200000",
    "number": "1124381025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 HAMPTON BLVD",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117587364",
            "telephone_number": "516-205-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 HAMPTON BLVD",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117587364",
            "telephone_number": "516-205-8822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDERMOTT-BANTA",
        "first_name": "TARA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-17",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "515741041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Luresa Lynn McCary, CEO
• Debra Jo McCavanagh, RN
• Megan Catherine McCormack, LMSW
• Richard Arthur McCormack, M.D., M.B.A.
• Thomas Joseph McCoy, LCSW
• Michael McDonald
• Nicole Danielle McDonough
• Sharon Smith McEvoy, RN, MA, NP-C,
• Megan Elizabeth McGovern, PHARMD
• Jenna McGuffey, OTR/L

• Specialist in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.