MEDICARE: DR. SHIRLEY AMANDA GAZABON PH.D.

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
1	103TC0700X	Clinical Psychologist	PY7129	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942251566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHIRLEY AMANDA GAZABON PH.D.

Provider Business Mailing Address
First Line	:	1695 NW 9TH AVENUE, SUITE 2423
Second Line	:	DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
City	:	MIAMI
State	:	FL
Zip	:	33136
Country	:	US
Telephone Number	:	305-355-8123
Fax Number	:	305-355-8095

Provider Business Practice Location Address
First Line	:	1695 NW 9TH AVENUE, SUITE 2423
Second Line	:	DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES
City	:	MIAMI
State	:	FL
Zip	:	33136-4350
Country	:	US
Telephone Number	:	305-355-8123
Fax Number	:	305-355-8095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/29/2011

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