Healthcare Provider Details

I. General information

NPI: 1811824816
Provider Name (Legal Business Name): BENJAMIN REX TEWHITI LOWRY PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2709
US

IV. Provider business mailing address

2563 PARK RIDGE ST
APOPKA FL
32712-5230
US

V. Phone/Fax

Practice location:
  • Phone: 904-809-8080
  • Fax: 904-809-8081
Mailing address:
  • Phone: 385-329-9723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY11486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: