Healthcare Provider Details

I. General information

NPI: 1588687362
Provider Name (Legal Business Name): TAMMY SHARADA HALL D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DELGADO ST SUITE D
SANTA FE NM
87501-2781
US

IV. Provider business mailing address

110 DELGADO ST SUITE D
SANTA FE NM
87501-2781
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4183
  • Fax: 505-982-9219
Mailing address:
  • Phone: 505-982-4183
  • Fax: 505-982-9219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number651
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: