Provider Demographics
NPI:1013516061
Name:TAMAYO DURUTY, GIDER
Entity Type:Individual
Prefix:MRS
First Name:GIDER
Middle Name:
Last Name:TAMAYO DURUTY
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 1:3907 GANDER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-7714
Mailing Address - Country:US
Mailing Address - Phone:407-558-6040
Mailing Address - Fax:407-386-7454
Practice Address - Street 1:5575 S SEMORAN BLVD STE 7
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1781
Practice Address - Country:US
Practice Address - Phone:321-400-5254
Practice Address - Fax:407-386-7454
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10723150Medicaid
FL107231500Medicaid