Provider Demographics
NPI:1245010040
Name:ROSS, TAMAYLA
Entity type:Individual
Prefix:
First Name:TAMAYLA
Middle Name:
Last Name:ROSS
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 1:1600 ELLA T GRASSO BLVD FL 1
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2977
Mailing Address - Country:US
Mailing Address - Phone:475-337-7510
Mailing Address - Fax:
Practice Address - Street 1:1600 ELLA T GRASSO BLVD FL 1
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2977
Practice Address - Country:US
Practice Address - Phone:475-337-7510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator