MEDICARE: MISS MIKAYLA JANAE DRYMOND ED.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC2200X	Clinical Child & Adolescent Psychologist

General Provider Information

NPI Number	:	1073289138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MIKAYLA JANAE DRYMOND ED.S.

Provider Business Mailing Address
First Line	:	15915 WOODPOST PL
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-1558
Country	:	US
Telephone Number	:	315-534-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 S BOULEVARD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1901
Country	:	US
Telephone Number	:	315-534-9112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	08/19/2021

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