Healthcare Provider Details

I. General information

NPI: 1013082163
Provider Name (Legal Business Name): SALLY GENE TAMAYO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR
PORTSMOUTH VA
23708-2111
US

IV. Provider business mailing address

1108 LAUDERDALE DR
CHESAPEAKE VA
23322-6909
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-9804
  • Fax: 757-953-0811
Mailing address:
  • Phone: 757-546-8218
  • Fax: 757-953-0811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA65303
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101266740
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2007-01754
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: