Provider Demographics
NPI:1760374607
Name:GOMO, GAMUCHIRAI
Entity type:Individual
Prefix:
First Name:GAMUCHIRAI
Middle Name:
Last Name:GOMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 LADY CATHERINE CIR
Mailing Address - Street 2:
Mailing Address - City:TRIANGLE
Mailing Address - State:VA
Mailing Address - Zip Code:22172-2330
Mailing Address - Country:US
Mailing Address - Phone:571-422-0329
Mailing Address - Fax:
Practice Address - Street 1:800 CORPORATE DR STE 301
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-4889
Practice Address - Country:US
Practice Address - Phone:571-422-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services