Provider Demographics
NPI:1407110059
Name:GUYTON, GABRIEL (MSED)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:GUYTON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 W 115TH ST
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7712
Mailing Address - Country:US
Mailing Address - Phone:828-335-0700
Mailing Address - Fax:
Practice Address - Street 1:610 W 112TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1898
Practice Address - Country:US
Practice Address - Phone:212-875-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY476583101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist