Provider Demographics
NPI:1386190122
Name:TAMAYO, AMANDA (BS)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12841 SW 43RD DR
Mailing Address - Street 2:256 A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4182
Mailing Address - Country:US
Mailing Address - Phone:305-807-8237
Mailing Address - Fax:
Practice Address - Street 1:12841 SW 43RD DR
Practice Address - Street 2:256 A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-4182
Practice Address - Country:US
Practice Address - Phone:305-807-8237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator