Healthcare Provider Details

I. General information

NPI: 1225933112
Provider Name (Legal Business Name): TAMARA NEE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 NORWICH NEW LONDON TPKE
UNCASVILLE CT
06382-1384
US

IV. Provider business mailing address

1920 NORWICH NEW LONDON TPKE
UNCASVILLE CT
06382-1384
US

V. Phone/Fax

Practice location:
  • Phone: 860-888-8777
  • Fax: 860-848-3388
Mailing address:
  • Phone: 860-888-8777
  • Fax: 860-848-3388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: