Provider Demographics
NPI:1699495374
Name:TAMAYO SUAREZ, ELEANE Y (PTA)
Entity type:Individual
Prefix:
First Name:ELEANE
Middle Name:Y
Last Name:TAMAYO SUAREZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 W 49TH ST STE 517
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2950
Mailing Address - Country:US
Mailing Address - Phone:786-663-7276
Mailing Address - Fax:305-397-2988
Practice Address - Street 1:1840 W 49TH ST STE 517
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2950
Practice Address - Country:US
Practice Address - Phone:786-663-7276
Practice Address - Fax:305-397-2988
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27682225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant