Provider Demographics
NPI:1720658032
Name:ZELAYA, GABRIELLA (OTHER)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:
Last Name:ZELAYA
Suffix:
Gender:F
Credentials:OTHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2209
Mailing Address - Country:US
Mailing Address - Phone:786-352-9529
Mailing Address - Fax:
Practice Address - Street 1:14401 OLD CUTLER RD
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1722
Practice Address - Country:US
Practice Address - Phone:786-573-7010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21303101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health