MEDICARE: DR. VINCENT SCHRODER 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	PY6063	FL

General Provider Information

NPI Number	:	1487654760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT SCHRODER PSYD

Provider Business Mailing Address
First Line	:	2630 NW 41ST ST
Second Line	:	D-3
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7495
Country	:	US
Telephone Number	:	352-372-9797
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 NW 41ST ST
Second Line	:	D-3
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-7495
Country	:	US
Telephone Number	:	352-372-9797
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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