Provider Demographics
NPI:1851289839
Name:GANDY, PORSHA K
Entity type:Individual
Prefix:
First Name:PORSHA
Middle Name:K
Last Name:GANDY
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 1:421 MIDVALE TER
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6621
Mailing Address - Country:US
Mailing Address - Phone:321-987-5182
Mailing Address - Fax:
Practice Address - Street 1:5240 BABCOCK ST NE STE 105
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4615
Practice Address - Country:US
Practice Address - Phone:321-750-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician