Healthcare Provider Details

I. General information

NPI: 1891029179
Provider Name (Legal Business Name): TASHAWNA K. DUNCAN, PH.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2009
Last Update Date: 09/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5245 OFFICE PARK BLVD STE 105
BRADENTON FL
34203-3444
US

IV. Provider business mailing address

5245 OFFICE PARK BLVD STE 105
BRADENTON FL
34203-3444
US

V. Phone/Fax

Practice location:
  • Phone: 941-751-7545
  • Fax: 941-755-2514
Mailing address:
  • Phone: 941-751-7545
  • Fax: 941-755-2514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY6421
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6421
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY6421
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6421
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY6421
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPY6421
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY6421
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY6421
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPY6421
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPY6421
License Number StateFL

VIII. Authorized Official

Name: DR. TASHAWNA KAY DUNCAN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 941-751-7545