Provider Demographics
NPI:1932145737
Name:TAMAYO CHELALA, ANDRE (DO)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:TAMAYO CHELALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4302 ALTON RD STE 750
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2893
Mailing Address - Country:US
Mailing Address - Phone:305-674-6797
Mailing Address - Fax:305-674-0784
Practice Address - Street 1:4302 ALTON RD STE 750
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2893
Practice Address - Country:US
Practice Address - Phone:305-674-6797
Practice Address - Fax:305-674-0784
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN203914OtherWELLCARE
110247108OtherRAILROAD MEDICARE
FL3439201OtherAETNA
FL037212OtherNHP
273039OtherAVMED
FL266357100Medicaid
FL51795OtherBCBS
FL7688881OtherGHI
FLN203914OtherSTAYWELL HEALTH PLAN