Provider Demographics
NPI:1417135963
Name:SIMPSON, TAMARA M (RD, CDN)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:M
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 EAST 54TH STREET
Mailing Address - Street 2:APT 6L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:718-531-2598
Mailing Address - Fax:
Practice Address - Street 1:1165 E 54TH ST
Practice Address - Street 2:APT 6L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2441
Practice Address - Country:US
Practice Address - Phone:718-531-2598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY847955133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered