Provider Demographics
NPI:1134905763
Name:GAYNOR, VERONICA LASHAWN
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:LASHAWN
Last Name:GAYNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:LASHAWN
Other - Last Name:GAYNOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12020 CITRUS LEAF DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-5658
Mailing Address - Country:US
Mailing Address - Phone:813-516-0444
Mailing Address - Fax:
Practice Address - Street 1:821 BRYAN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6132
Practice Address - Country:US
Practice Address - Phone:813-548-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities