Healthcare Provider Details

I. General information

NPI: 1568627529
Provider Name (Legal Business Name): TAMARA T MYERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA RENE TENNILLE MD

II. Dates (important events)

Enumeration Date: 07/18/2008
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 CANAL LANDING BLVD STE 6
ROCHESTER NY
14626-5112
US

IV. Provider business mailing address

100 KINGS HWY S STE 1400
ROCHESTER NY
14617-5541
US

V. Phone/Fax

Practice location:
  • Phone: 585-247-4770
  • Fax: 585-247-4268
Mailing address:
  • Phone: 585-922-3027
  • Fax: 585-922-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number344680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: