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MRS. TYESHA DOMINIQUE
NPI 1376714139
Physician Assistant in New York, NY

Active since March 19, 2008PECOS Enrolled
312 E 94TH ST, NEW YORK, NY 10128(212) 423-3000(212) 423-2920 Get Directions Write a Review

NPPES record last updated: March 19, 2008. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mrs. Tyesha Dominique NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. TYESHA DOMINIQUE (NPI 1376714139) is an individual physician assistant in New York, New York, licensed in New York (012331) and active in the NPI registry since March 2008. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376714139
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMRS. TYESHA DOMINIQUE
Location Address312 E 94TH STNew York, NY 10128-5604
Mailing Address312 E 94th StNew York, NY 10128-5604 · (212) 423-3000 · Fax (212) 423-2920
Phone(212) 423-3000
Fax(212) 423-2920
Sole ProprietorNo
Enumeration DateMarch 19, 2008
✔ NPI 1376714139 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in NY · 012331
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
312 E 94TH ST, New York, NY 10128
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Tyesha Dominique is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 10128 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$102.04 typical visit price
range $65.69 – $198.19
Typical copayment $25.51 (range $16.42 – $49.54)
Most-billed visit code 99203
Established Patient
$81.44 typical visit price
range $21.20 – $160.66
Typical copayment $20.36 (range $5.30 – $40.16)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. JILLIAN ELYSE BERRIDGE LMSW
Social Worker
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-3000
MS. BETHANY NOVAK FNP
Clinic/Center (Adolescent and Children Mental Health)
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-2900
SHARON EDWARDS M.D
Pediatrics (Adolescent Medicine)
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-2900
MS. JENNIFER ELLIOTT LMSW
Social Worker
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-3000
LINDSAY MCCONNELL ALLEN PA
Physician Assistant
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-3000
DR. KATHERINE MARY MALBON M.D.
Pediatrics (Adolescent Medicine)
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 731-7639
DR. MICHAEL DAVID KISICKI MD
Psychiatry & Neurology (Psychiatry)
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-3000
DR. DORIS PASTORE MD
Clinic/Center (Adolescent and Children Mental Health)
312 E 94TH ST
NEW YORK, NY 10128
New York County (212) 423-2900

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyesha Dominique's NPI number?

The NPI number for Tyesha Dominique is 1376714139. It was assigned to this individual provider in the NPPES registry on March 19, 2008.

Where is Tyesha Dominique located?

Tyesha Dominique practices at 312 E 94th St, New York, NY 10128. The listed phone number is (212) 423-3000.

What is Tyesha Dominique's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Tyesha Dominique enrolled in Medicare?

Yes. Tyesha Dominique is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Tyesha Dominique was last updated on March 19, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.