Provider Demographics
NPI:1891802591
Name:CONSTANTINO, TAWNYA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TAWNYA
Middle Name:M
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9800
Mailing Address - Fax:801-507-9801
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:SUITE 810
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9800
Practice Address - Fax:801-507-9801
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT312149-12052084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG94368Medicare ID - Type Unspecified