Provider Demographics
NPI:1588906101
Name:SYMONETTE, TANYA LYNN (DOM)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:SYMONETTE
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 SW 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1467
Mailing Address - Country:US
Mailing Address - Phone:954-290-1974
Mailing Address - Fax:
Practice Address - Street 1:4505 W FLAGLER ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-1500
Practice Address - Country:US
Practice Address - Phone:786-364-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 3235171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist