Healthcare Provider Details

I. General information

NPI: 1942251566
Provider Name (Legal Business Name): SHIRLEY AMANDA GAZABON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVENUE, SUITE 2423 DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
MIAMI FL
33136-4350
US

IV. Provider business mailing address

1695 NW 9TH AVENUE, SUITE 2423 DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-8123
  • Fax: 305-355-8095
Mailing address:
  • Phone: 305-355-8123
  • Fax: 305-355-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7129
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: