Provider Demographics
NPI:1760036883
Name:MIYAMOTO, TAMMY-DAWN A
Entity Type:Individual
Prefix:
First Name:TAMMY-DAWN
Middle Name:A
Last Name:MIYAMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45-674 HALEKOU RD
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-1767
Mailing Address - Country:US
Mailing Address - Phone:808-341-8223
Mailing Address - Fax:
Practice Address - Street 1:3440 LEAHI AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-4235
Practice Address - Country:US
Practice Address - Phone:808-341-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist