Provider Demographics
NPI:1316077514
Name:GANDY-WALKER, PARIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:PARIS
Middle Name:
Last Name:GANDY-WALKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PARIS
Other - Middle Name:
Other - Last Name:GANDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1848 SE 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2875
Mailing Address - Country:US
Mailing Address - Phone:954-885-9500
Mailing Address - Fax:
Practice Address - Street 1:1848 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2875
Practice Address - Country:US
Practice Address - Phone:954-885-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY019206103TC0700X
GAPSY003710103TC0700X
FLPY9758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health