Provider Demographics
NPI:1316437015
Name:GALLMAN, KIMYATTA SHELENA (MED)
Entity type:Individual
Prefix:
First Name:KIMYATTA
Middle Name:SHELENA
Last Name:GALLMAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5607 GAINOR RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1330
Mailing Address - Country:US
Mailing Address - Phone:215-879-2713
Mailing Address - Fax:
Practice Address - Street 1:5607 GAINOR RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1330
Practice Address - Country:US
Practice Address - Phone:215-879-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health