1790857464 NPI number — TAWNYA MARIE KUMARAKULASINGAM PH.D., NCSP

Table of content: TAWNYA MARIE KUMARAKULASINGAM PH.D., NCSP (NPI 1790857464)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790857464 NPI number — TAWNYA MARIE KUMARAKULASINGAM PH.D., NCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUMARAKULASINGAM
Provider First Name:
TAWNYA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D., NCSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790857464
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
649 E EL PRADO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHANDLER
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85225-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-786-9479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3205 S RURAL RD
Provider Second Line Business Practice Location Address:
TEMPE ELEMENTARY SCHOOL DISTRICT #3
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-3853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-966-7114
Provider Business Practice Location Address Fax Number:
480-829-6178
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 728199 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".