Provider Demographics
NPI:1538598263
Name:GRANDOIT, TAMARA
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:
Last Name:GRANDOIT
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 1:8119 LEE HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3444
Mailing Address - Country:US
Mailing Address - Phone:678-330-3411
Mailing Address - Fax:
Practice Address - Street 1:8119 LEE HALL AVE
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3444
Practice Address - Country:US
Practice Address - Phone:678-330-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities