Healthcare Provider Details

I. General information

NPI: 1619919321
Provider Name (Legal Business Name): PATRICK J BEAHON M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MASON ST
BRANDON FL
33511-5210
US

IV. Provider business mailing address

8120 STONE PATH WAY
TAMPA FL
33647-3631
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-7441
  • Fax: 813-689-3815
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS0000619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: