MEDICARE: CASSANDRA ANANDAPPA TAMAYO DO

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	390200000X	Student in an Organized Health Care Education/Training Program	125071162	IL
2	207Q00000X	Family Medicine Physician	34.014696	OH

General Provider Information

NPI Number	:	1326578089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA ANANDAPPA TAMAYO DO

Provider Business Mailing Address
First Line	:	3021 CRANSTON DR
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-1713
Country	:	US
Telephone Number	:	773-331-8057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3667 MARLANE DR
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-8895
Country	:	US
Telephone Number	:	614-277-9631
Fax Number	:

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

Provider Enumeration Date	:	06/15/2017
Last Update Date	:	07/27/2020

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