Active NPI
Tainiz Polanco
- Psychiatry Physician
- Bryn Mawr, PA
National Provider Identifier
1710819636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- OT025565
- Practice address
- 130 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3143 - Phone
- (484) 337-3050
- NPI assigned
- Jun 3, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | OT025565 | PA | Primary |
Addresses
Primary practice location
130 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3143
Mailing address
130 S Bryn Mawr Ave
Bryn Mawr, PA 19010-3143
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260618004207 | PA | Order and Referring Only - Psychiatry | 3971075011 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT025565 | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1780444800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1780444800000",
"number": "1710819636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 S BRYN MAWR AVE",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "190103143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 S BRYN MAWR AVE",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "190103143",
"telephone_number": "484-337-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLANCO",
"first_name": "TAINIZ",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-06-03",
"last_updated": "2026-06-03",
"certification_date": "2026-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "OT025565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bryn Mawr, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.