Provider Demographics
NPI:1104695303
Name:GALLESE, ROBIN D
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:D
Last Name:GALLESE
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 1:901 FIDDLERS WAY
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1278
Mailing Address - Country:US
Mailing Address - Phone:440-823-0462
Mailing Address - Fax:
Practice Address - Street 1:901 FIDDLERS WAY
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1278
Practice Address - Country:US
Practice Address - Phone:440-823-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health