Healthcare Provider Details

I. General information

NPI: 1265697973
Provider Name (Legal Business Name): DR. SIDHBH GALLAGHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 SW 37TH ST. 803
MIAMI BEACH FL
33133
US

IV. Provider business mailing address

2601 SW 37TH ST. 803
MIAMI FL
33133
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME140163
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number10174677A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: