Healthcare Provider Details

I. General information

NPI: 1376538645
Provider Name (Legal Business Name): GABRIELLE HOPE MAYERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1447 MEDICAL PARK BLVD SUITE 402
WELLINGTON FL
33414
US

IV. Provider business mailing address

900 S PINE ISLAND RD SUITE 800
PLANTATION FL
33324-3920
US

V. Phone/Fax

Practice location:
  • Phone: 561-790-2600
  • Fax: 561-790-1535
Mailing address:
  • Phone: 561-336-0191
  • Fax: 561-364-7785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number207572
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME121088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: