Individual
EDLIRA TAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
101 NICOLLS RD, STONY BROOK, NY 11794-8160
(631) 444-3278
Mailing address
101 NICOLLS RD, STONY BROOK, NY 11794-8160
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1265850093
OH
207RA0001X
Advanced Heart Failure and Transplant Cardiology Physician
Primary
309804
NY
207RC0000X
Cardiovascular Disease Physician
Primary
1265850093
NY
Other
Enumeration date
03/29/2014
Last updated
02/22/2026
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