Healthcare Provider Details

I. General information

NPI: 1184004616
Provider Name (Legal Business Name): CHRISTOPHER NICHOLAS SOZDA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER RD PSYCHOLOGY SERVICE
GAINESVILLE FL
32608-1135
US

IV. Provider business mailing address

1601 SW ARCHER ROAD PSYCHOLOGY SERVICE
GAINESVILLE FL
32608
US

V. Phone/Fax

Practice location:
  • Phone: 352-548-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 9176
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY9176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: