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General NPI Number Information
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NPI Number | 1811939515
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Entity Type | Individual
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Provider Name | KHALIL A SAKALLA PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1601 SW ARCHER RD
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City | GAINESVILLE
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State | FL
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Zip | 32608-1135
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Country | US
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Telephone | 352-281-8526
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Fax | 352-331-8341
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Provider Business Mailing Address
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Address Line | PO BOX 358372
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City | GAINESVILLE
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State | FL
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Zip | 32635-8372
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Country | US
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Telephone | 352-281-8526
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Fax | 352-331-8341
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY7142
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License Number State | FL
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