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General NPI Number Information
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NPI Number | 1093506958
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Entity Type | Individual
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Provider Name | TAMARA DAVYDOVA FNP-BC, WCC, OMS
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 14404 69TH RD
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City | FLUSHING
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State | NY
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Zip | 11367-1702
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Country | US
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Telephone | 347-656-3730
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Fax |
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Provider Business Mailing Address
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Address Line | 14404 69TH RD
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City | FLUSHING
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State | NY
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Zip | 11367-1702
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Country | US
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Telephone | 347-656-3730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F355879-07
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | F355879-07
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 620695
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 163WX1500X
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Taxonomy Name | Ostomy Care Registered Nurse
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License Number | 620695
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License Number State | NY
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