Provider Demographics
NPI:1588687362
Name:HALL, TAMMY SHARADA (DOM)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:SHARADA
Last Name:HALL
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 DELGADO ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-2781
Mailing Address - Country:US
Mailing Address - Phone:505-982-4183
Mailing Address - Fax:505-982-9219
Practice Address - Street 1:110 DELGADO ST
Practice Address - Street 2:SUITE D
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-2781
Practice Address - Country:US
Practice Address - Phone:505-982-4183
Practice Address - Fax:505-982-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM651171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMOONMOORG36OtherBLUE CROSS BLUE SHIELD