Provider Demographics
NPI:1104311075
Name:GAZY, NICKY
Entity type:Individual
Prefix:
First Name:NICKY
Middle Name:
Last Name:GAZY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21097 NE 27TH CT STE 500
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1235
Mailing Address - Country:US
Mailing Address - Phone:305-931-6661
Mailing Address - Fax:
Practice Address - Street 1:3 SW 129TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1778
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101024255207N00000X
MI5151011340207N00000X
FLOS19219207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology