Healthcare Provider Details

I. General information

NPI: 1831061704
Provider Name (Legal Business Name): VERONICA E GBAGO MASTER OF PUB HEALTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2025
Last Update Date: 09/20/2025
Certification Date: 09/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BEGONIA CV APT 212
SANFORD FL
32771-6521
US

IV. Provider business mailing address

4200 BEGONIA CV APT 212
SANFORD FL
32771-6521
US

V. Phone/Fax

Practice location:
  • Phone: 407-319-6686
  • Fax:
Mailing address:
  • Phone: 407-319-6686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: