MEDICARE: GANDELL WORLD ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	SW3298	FL

General Provider Information

NPI Number	:	1619159803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANDELL WORLD ENTERPRISES INC

Provider Business Mailing Address
First Line	:	PO BOX 271384
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33688-1384
Country	:	US
Telephone Number	:	813-282-3618
Fax Number	:	813-289-6906

Provider Business Practice Location Address
First Line	:	4406 MELTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7218
Country	:	US
Telephone Number	:	407-873-0759
Fax Number	:	813-289-6906

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARIA D GANDELL
Credential	:	PH.D.
Telephone Number	:	813-282-3618

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	10/09/2008

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