Provider Demographics
NPI:1457412173
Name:GAMBY, TANYA E (PHD)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:E
Last Name:GAMBY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 ELUA ST
Mailing Address - Street 2:STE C
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1203
Mailing Address - Country:US
Mailing Address - Phone:808-821-2027
Mailing Address - Fax:808-821-2028
Practice Address - Street 1:3175 ELUA ST
Practice Address - Street 2:STE C
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1203
Practice Address - Country:US
Practice Address - Phone:808-821-2027
Practice Address - Fax:808-821-2028
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY873103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI575411420OtherHMSA
HIPSY873OtherMDX
HI249698OtherHMSA
HI1426681OtherUHA
HI55958601Medicaid