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NPI Code Detail

MEDICARE: QUANAZHEA DONYEA GORHAM

MEDICARE: QUANAZHEA DONYEA GORHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1093332173
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUANAZHEA DONYEA GORHAM
Provider Business Mailing Address
First Line : 5707 N 22ND ST
Second Line :
City : TAMPA
State : FL
Zip : 33610-4350
Country : US
Telephone Number : 813-239-8069
Fax Number : 813-231-4350
Provider Business Practice Location Address
First Line : 5800 N NEBRASKA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33604-7128
Country : US
Telephone Number : 813-239-8069
Fax Number : 813-231-7324
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2020
Last Update Date : 11/02/2023

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Directions to “ QUANAZHEA DONYEA GORHAM ” Practice Location

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