Provider Demographics
NPI:1659591493
Name:GONSALVES, DAWN AMANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:AMANDA
Last Name:GONSALVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:905 GREENE CO OFFICE BLDG
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413
Mailing Address - Country:US
Mailing Address - Phone:518-622-9163
Mailing Address - Fax:518-622-8592
Practice Address - Street 1:905 GREENE CO OFFICE BLDG
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12413
Practice Address - Country:US
Practice Address - Phone:518-622-9163
Practice Address - Fax:518-622-8592
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2438272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY243827OtherLICENSE
NY243827OtherLICENSE