Provider Demographics
NPI:1598039026
Name:DAYSTAR, TARA (BA CPM, IBCLC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DAYSTAR
Suffix:
Gender:F
Credentials:BA CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 BETHLEHEM CHURCH RD NE
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-2256
Mailing Address - Country:US
Mailing Address - Phone:540-285-0067
Mailing Address - Fax:
Practice Address - Street 1:829 BETHLEHEM CHURCH RD NE
Practice Address - Street 2:
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2256
Practice Address - Country:US
Practice Address - Phone:540-285-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2022-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 374J00000X
VA0129000069176B00000X
VAL-301284174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No174H00000XOther Service ProvidersHealth Educator
No176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula