Healthcare Provider Details

I. General information

NPI: 1013516061
Provider Name (Legal Business Name): MRS. GIDER TAMAYO DURUTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 S SEMORAN BLVD STE 7
ORLANDO FL
32822-1781
US

IV. Provider business mailing address

3907 GANDER CT
ORLANDO FL
32822-7714
US

V. Phone/Fax

Practice location:
  • Phone: 321-400-5254
  • Fax: 407-386-7454
Mailing address:
  • Phone: 407-558-6040
  • Fax: 407-386-7454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: