Provider Demographics
NPI:1457036600
Name:VALDERRAMA, TABATHA RENEE (BA, IBCLC)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:RENEE
Last Name:VALDERRAMA
Suffix:
Gender:F
Credentials:BA, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 WARREN ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-2754
Mailing Address - Country:US
Mailing Address - Phone:941-223-8001
Mailing Address - Fax:
Practice Address - Street 1:571 WARREN ST APT 1R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2754
Practice Address - Country:US
Practice Address - Phone:941-223-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL-311112174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN