Healthcare Provider Details

I. General information

NPI: 1871163501
Provider Name (Legal Business Name): WINSTON GAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7044 E THUNDERBIRD RD
SCOTTSDALE AZ
85254-4049
US

IV. Provider business mailing address

7044 E THUNDERBIRD RD
SCOTTSDALE AZ
85254-4049
US

V. Phone/Fax

Practice location:
  • Phone: 609-456-5625
  • Fax: 480-795-8812
Mailing address:
  • Phone: 609-456-5625
  • Fax: 480-795-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: