Provider Demographics
NPI:1164156881
Name:GAYDOS, PATRICIA VICTORIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:VICTORIA
Last Name:GAYDOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1758
Mailing Address - Country:US
Mailing Address - Phone:765-729-4108
Mailing Address - Fax:
Practice Address - Street 1:3000 N LINDEN ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1758
Practice Address - Country:US
Practice Address - Phone:765-729-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator