Healthcare Provider Details

I. General information

NPI: 1861054801
Provider Name (Legal Business Name): JAY SWEATT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2019
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 MARILYN ST # D225
CLEARWATER FL
33765-2523
US

IV. Provider business mailing address

2060 MARILYN ST # D225
CLEARWATER FL
33765-2523
US

V. Phone/Fax

Practice location:
  • Phone: 813-953-7668
  • Fax:
Mailing address:
  • Phone: 813-953-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: