Provider Demographics
NPI:1659007821
Name:ALLAM, GABRIELLA ANNE
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:ANNE
Last Name:ALLAM
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 1:71 N CAPTAINS NECK LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3972
Mailing Address - Country:US
Mailing Address - Phone:631-495-2266
Mailing Address - Fax:
Practice Address - Street 1:71 N CAPTAINS NECK LN
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3972
Practice Address - Country:US
Practice Address - Phone:631-495-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)