Healthcare Provider Details

I. General information

NPI: 1700077724
Provider Name (Legal Business Name): JASON ANDREW DEMERY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 NW 39TH AVE UF SPRINGHILL HEALTH CENTER
GAINESVILLE FL
32606-5635
US

IV. Provider business mailing address

8491 NW 39TH AVE UF SPRINGHILL HEALTH CENTER
GAINESVILLE FL
32606-5635
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-3284
  • Fax: 352-265-3285
Mailing address:
  • Phone: 352-265-3284
  • Fax: 352-265-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7500
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: