Healthcare Provider Details

I. General information

NPI: 1639186935
Provider Name (Legal Business Name): DEIDRE BYRNES PEREIRA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEIDRE BYRNES PEREIRA

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD
GAINESVILLE FL
32610-0371
US

IV. Provider business mailing address

PO BOX 918025
ORLANDO FL
32891-8025
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6039
  • Fax: 352-273-6156
Mailing address:
  • Phone: 352-273-6039
  • Fax: 352-273-6159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY6849
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: