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General NPI Number Information
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NPI Number | 1447860283
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Entity Type | Individual
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Provider Name | ABIGALE JEAN BRADY SANBORN PHD
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Gender | Female
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 6000 US98
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City | PENSACOLA
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State | FL
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Zip | 32512-1337
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Country | US
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Telephone | 850-505-6749
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Fax |
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Provider Business Mailing Address
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Address Line | 6000 US 98
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City | PENSACOLA
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State | FL
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Zip | 32512-0001
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Country | US
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Telephone | 440-813-0014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810008074
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License Number State | VA
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