Provider Demographics
NPI:1326578089
Name:TAMAYO, CASSANDRA ANANDAPPA (DO)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ANANDAPPA
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:ANANDAPPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3021 CRANSTON DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1713
Mailing Address - Country:US
Mailing Address - Phone:773-331-8057
Mailing Address - Fax:
Practice Address - Street 1:3667 MARLANE DR
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8895
Practice Address - Country:US
Practice Address - Phone:614-277-9631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125071162390200000X
OH34.014696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program