Provider Demographics
NPI:1225264047
Name:MAHER, GAIELLE A (PA)
Entity Type:Individual
Prefix:
First Name:GAIELLE
Middle Name:A
Last Name:MAHER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:6730 MIRAMAR PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-4838
Practice Address - Country:US
Practice Address - Phone:954-276-6601
Practice Address - Fax:954-985-3917
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9100874363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007375300Medicaid