=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942251566
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIRLEY AMANDA GAZABON PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2006
-----------------------------------------------------
Last Update Date | 07/29/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1695 NW 9TH AVENUE, SUITE 2423 DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-4350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-355-8123
-----------------------------------------------------
Fax | 305-355-8095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1695 NW 9TH AVENUE, SUITE 2423 DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-355-8123
-----------------------------------------------------
Fax | 305-355-8095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY7129
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------