Provider Demographics
NPI:1871015966
Name:FORDE, TAMMARA KIMBERLY (SPECIALIST)
Entity Type:Individual
Prefix:MISS
First Name:TAMMARA
Middle Name:KIMBERLY
Last Name:FORDE
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1248 SAINT MARKS AVE APT 4G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-2471
Mailing Address - Country:US
Mailing Address - Phone:646-318-1081
Mailing Address - Fax:347-715-7024
Practice Address - Street 1:116 W 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3212
Practice Address - Country:US
Practice Address - Phone:646-318-1081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist