Healthcare Provider Details

I. General information

NPI: 1073959540
Provider Name (Legal Business Name): AMY MICHELE MILAM EDD, NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 W BRANDON BLVD SUITE 205
BRANDON FL
33511-4730
US

IV. Provider business mailing address

2130 W BRANDON BLVD SUITE 205
BRANDON FL
33511-4730
US

V. Phone/Fax

Practice location:
  • Phone: 813-453-5760
  • Fax:
Mailing address:
  • Phone: 813-453-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS0000707
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: