Provider Demographics
NPI:1760638464
Name:GANDY, VIVIAN MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:MARIE
Last Name:GANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 71ST ST
Mailing Address - Street 2:SUITE 620
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3089
Mailing Address - Country:US
Mailing Address - Phone:305-866-9951
Mailing Address - Fax:877-284-8933
Practice Address - Street 1:300 71ST ST
Practice Address - Street 2:SUITE 620
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-3089
Practice Address - Country:US
Practice Address - Phone:305-866-9951
Practice Address - Fax:877-284-8933
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044997E208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00688655OtherRAILROAD MEDICARE
PA001528765Medicaid
PAP00688655OtherRAILROAD MEDICARE