MEDICARE: TANYA E GAMBY PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY873	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	575411420	OTHER	HI	HMSA
2	PSY873	OTHER	HI	MDX
3	249698	OTHER	HI	HMSA
4	1426681	OTHER	HI	UHA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457412173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA E GAMBY PHD

Provider Business Mailing Address
First Line	:	3175 ELUA ST
Second Line	:	STE C
City	:	LIHUE
State	:	HI
Zip	:	96766-1203
Country	:	US
Telephone Number	:	808-821-2027
Fax Number	:	808-821-2028

Provider Business Practice Location Address
First Line	:	3175 ELUA ST
Second Line	:	STE C
City	:	LIHUE
State	:	HI
Zip	:	96766-1203
Country	:	US
Telephone Number	:	808-821-2027
Fax Number	:	808-821-2028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/27/2018

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Directions to “ TANYA E GAMBY PHD” Practice Location

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