Provider Demographics
NPI:1942755228
Name:GAILYARD, SINADIA ELLISE (IMH)
Entity Type:Individual
Prefix:
First Name:SINADIA
Middle Name:ELLISE
Last Name:GAILYARD
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11474 WILLET CT S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-2545
Mailing Address - Country:US
Mailing Address - Phone:904-742-6715
Mailing Address - Fax:
Practice Address - Street 1:11474 WILLET CT S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-2545
Practice Address - Country:US
Practice Address - Phone:904-742-6715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 14386101Y00000X
FLMH15950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor