Healthcare Provider Details

I. General information

NPI: 1528708450
Provider Name (Legal Business Name): TAMARA KONOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WILLOW DR
ORLANDO FL
32807-3220
US

IV. Provider business mailing address

244 BARTON BLVD UNIT 211
ROCKLEDGE FL
32955-2859
US

V. Phone/Fax

Practice location:
  • Phone: 321-346-8450
  • Fax:
Mailing address:
  • Phone: 321-604-8918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: