MEDICARE: MS. TANYA ANDREA OPPENHEIMER PSYD

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	103T00000X	Psychologist	6879	FL
2	103T00000X	Psychologist	18942	CA
3	103T00000X	Psychologist	16748	NY

General Provider Information

NPI Number	:	1235153875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANYA ANDREA OPPENHEIMER PSYD

Provider Business Mailing Address
First Line	:	3308 W DEWEY ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1517
Country	:	US
Telephone Number	:	813-966-8456
Fax Number	:	813-873-7650

Provider Business Practice Location Address
First Line	:	3308 W DEWEY ST
Second Line	:	MOBILE
City	:	TAMPA
State	:	FL
Zip	:	33607-1517
Country	:	US
Telephone Number	:	813-966-8456
Fax Number	:	813-873-7650

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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