Provider Demographics
NPI:1265224539
Name:GONCALVES, MARY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:GONCALVES
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 1:2133 SUGAR MILL DR # 1
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-1227
Mailing Address - Country:US
Mailing Address - Phone:973-271-6993
Mailing Address - Fax:
Practice Address - Street 1:2133 SUGAR MILL DR # 1
Practice Address - Street 2:
Practice Address - City:NOLENSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37135-1227
Practice Address - Country:US
Practice Address - Phone:973-271-6993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-21
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program