Healthcare Provider Details

I. General information

NPI: 1922334002
Provider Name (Legal Business Name): SUNCOAST NEUROPSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CYPRESS VILLAGE BLVD
RUSKIN FL
33573-6822
US

IV. Provider business mailing address

235 APOLLO BEACH BLVD # 506
APOLLO BEACH FL
33572-2251
US

V. Phone/Fax

Practice location:
  • Phone: 813-633-6000
  • Fax:
Mailing address:
  • Phone: 813-633-6000
  • Fax: 813-633-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY7611
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7611
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY7611
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7611
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY7611
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY7611
License Number StateFL

VIII. Authorized Official

Name: DR. RHONDA MICHELLE ROSS
Title or Position: OWNER
Credential: PSYD
Phone: 813-633-6000