Basic Information
| Provider Information | |||||||||
| NPI: | 1962603399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GONSALVES SIKORA | ||||||||
| FirstName: | ALITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1255 37TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329606550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722286882 | ||||||||
| FaxNumber: | 7722286883 | ||||||||
| Practice Location | |||||||||
| Address1: | 1255 37TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329606550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722286882 | ||||||||
| FaxNumber: | 7722286883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2007 | ||||||||
| LastUpdateDate: | 08/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | ME99541 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 05637 | 01 | FL | BCBS | OTHER | 280563400 | 05 | FL | MEDICAID |