Provider Demographics
NPI:1124175823
Name:ENID GILDAR, MA, CCC,PA
Entity type:Organization
Organization Name:ENID GILDAR, MA, CCC,PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENID
Authorized Official - Middle Name:STALLER
Authorized Official - Last Name:GILDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC
Authorized Official - Phone:813-933-7300
Mailing Address - Street 1:8019 N HIMES AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2712
Mailing Address - Country:US
Mailing Address - Phone:813-933-7300
Mailing Address - Fax:813-933-3550
Practice Address - Street 1:8019 N HIMES AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2712
Practice Address - Country:US
Practice Address - Phone:813-933-7300
Practice Address - Fax:813-933-3550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA235225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL296120OtherAVMED
FLTINOtherTAX I.D #
FLRAM4605065OtherAMERICHOICE
FLS0995OtherBLUE CROSS BLUE SHEILD
FLV0491001OtherCITRUS HEALTHCARE
FL205812OtherAMERIGROUP OF FLORIDA, IN