Healthcare Provider Details

I. General information

NPI: 1760288054
Provider Name (Legal Business Name): BELINDA ROSE TAMBASCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W ONONDAGA ST
SYRACUSE NY
13202-3265
US

IV. Provider business mailing address

321 W ONONDAGA ST
SYRACUSE NY
13202-3265
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-0610
  • Fax: 315-478-2510
Mailing address:
  • Phone: 315-478-0610
  • Fax: 315-478-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number517820
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number517820
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number517820
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number517820
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: