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1740697986

NPI Code Detail

MEDICARE: DR. NINA CARMELA ROSALES TAMAYO DO, MS, MPH

MEDICARE: DR. NINA CARMELA ROSALES TAMAYO DO, MS, MPH

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	2081P0004X	Spinal Cord Injury Medicine Physician	H0102338	MD
2	208100000X	Physical Medicine & Rehabilitation Physician	02008653A	IN
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2081P0004X	Spinal Cord Injury Medicine Physician	34.013457	OH

General Provider Information

NPI Number	:	1740697986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NINA CARMELA ROSALES TAMAYO DO, MS, MPH

Provider Business Mailing Address
First Line	:	11800 EDGEWATER DR APT 1016
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-1760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4389 MEDINA RD
Second Line	:
City	:	COPLEY
State	:	OH
Zip	:	44321-1388
Country	:	US
Telephone Number	:	708-525-1058
Fax Number	:

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

Provider Enumeration Date	:	07/21/2014
Last Update Date	:	01/20/2026

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Directions to “ DR. NINA CARMELA ROSALES TAMAYO DO, MS, MPH” Practice Location

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