MEDICARE: TAMIRA VANNOY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	NOO5267	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295742716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMIRA VANNOY

Provider Business Mailing Address
First Line	:	1027 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2812
Country	:	US
Telephone Number	:	718-348-5981
Fax Number	:	718-345-5139

Provider Business Practice Location Address
First Line	:	1027 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2812
Country	:	US
Telephone Number	:	718-348-5981
Fax Number	:	718-345-5139

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	06/14/2011

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Directions to “ TAMIRA VANNOY ” Practice Location

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