Healthcare Provider Details

I. General information

NPI: 1750436374
Provider Name (Legal Business Name): MICHAEL P GAMACHE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13902 N DALE MABRY HWY SUITE 101
TAMPA FL
33618-2415
US

IV. Provider business mailing address

13902 N DALE MABRY HWY SUITE 101
TAMPA FL
33618-2415
US

V. Phone/Fax

Practice location:
  • Phone: 813-264-9600
  • Fax: 813-264-9610
Mailing address:
  • Phone: 813-264-9600
  • Fax: 813-264-9610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY3577
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3577
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY3577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: