Provider Demographics
NPI:1801009543
Name:SHAMY, TARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:SHAMY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 SUNNY LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9282
Mailing Address - Country:US
Mailing Address - Phone:419-517-3066
Mailing Address - Fax:
Practice Address - Street 1:3830 WOODLEY RD
Practice Address - Street 2:SUITE C
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1176
Practice Address - Country:US
Practice Address - Phone:419-475-5433
Practice Address - Fax:419-475-4770
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088831208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics