Healthcare Provider Details

I. General information

NPI: 1437771615
Provider Name (Legal Business Name): GABRIELLE DEMAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48-6 REVERE RD APT 6
DREXEL HILL PA
19026-5367
US

IV. Provider business mailing address

4 CRABAPPLE CT
MULLICA HILL NJ
08062-9478
US

V. Phone/Fax

Practice location:
  • Phone: 164-668-3034
  • Fax:
Mailing address:
  • Phone: 609-970-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-51833
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: