Healthcare Provider Details

I. General information

NPI: 1982627352
Provider Name (Legal Business Name): TAMMY TADOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

IV. Provider business mailing address

525 TECHNOLOGY PARK STE 109
LAKE MARY FL
32746-7107
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-2346
  • Fax: 407-647-5431
Mailing address:
  • Phone: 407-647-2346
  • Fax: 407-647-5431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberME78176
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME78176
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberME78176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: