Provider Demographics
NPI:1962603399
Name:GONSALVES SIKORA, ALITA (MD)
Entity type:Individual
Prefix:DR
First Name:ALITA
Middle Name:
Last Name:GONSALVES SIKORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 37TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6550
Mailing Address - Country:US
Mailing Address - Phone:772-228-6882
Mailing Address - Fax:772-228-6883
Practice Address - Street 1:1255 37TH ST STE B
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-228-6882
Practice Address - Fax:772-228-6883
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99541208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL05637OtherBCBS
FL280563400Medicaid
FL05637OtherBCBS
FL0167320001Medicare NSC
FL280563400Medicaid