Healthcare Provider Details

I. General information

NPI: 1508202326
Provider Name (Legal Business Name): EMILY BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 04/30/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 E STATE ROAD 64
BRADENTON FL
34208-9040
US

IV. Provider business mailing address

4895 WILDE POINTE DR
SARASOTA FL
34233-3542
US

V. Phone/Fax

Practice location:
  • Phone: 941-748-2697
  • Fax:
Mailing address:
  • Phone: 941-928-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: