Provider Demographics
NPI:1538567821
Name:SIMS-DORWAY, TAMARA (RD)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SIMS-DORWAY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W GORE ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1141
Mailing Address - Country:US
Mailing Address - Phone:321-841-3338
Mailing Address - Fax:321-841-2170
Practice Address - Street 1:60 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1141
Practice Address - Country:US
Practice Address - Phone:321-841-3338
Practice Address - Fax:321-841-2170
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND3655133VN1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN/AMedicaid
FLND3655OtherMEDICAL LICENSE
FLN/AMedicare PIN