Healthcare Provider Details

I. General information

NPI: 1417687674
Provider Name (Legal Business Name): VANESSA LUCIA GAGLIANO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SE 15TH TER STE 102
DEERFIELD BEACH FL
33441-4464
US

IV. Provider business mailing address

1980 S OCEAN DR APT 8J
HALLANDALE BEACH FL
33009-5935
US

V. Phone/Fax

Practice location:
  • Phone: 954-428-2002
  • Fax: 954-427-4614
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6135
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: