Healthcare Provider Details

I. General information

NPI: 1447860283
Provider Name (Legal Business Name): ABIGALE JEAN BRADY SANBORN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBIE JEAN BRADY MS

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 US98
PENSACOLA FL
32512-1337
US

IV. Provider business mailing address

6000 US 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6749
  • Fax:
Mailing address:
  • Phone: 440-813-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810008074
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: