Healthcare Provider Details

I. General information

NPI: 1063918290
Provider Name (Legal Business Name): TAMMY TAVDY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST # 651
BRONX NY
10467-2401
US

IV. Provider business mailing address

111 E 210TH ST # 651
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-4417
  • Fax: 718-920-8375
Mailing address:
  • Phone: 718-920-4417
  • Fax: 718-920-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number309112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: