Healthcare Provider Details

I. General information

NPI: 1720037591
Provider Name (Legal Business Name): CANDICE KAY STEWART-SABIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 10TH AVE N SUITE 103
SAFETY HARBOR FL
34695-3407
US

IV. Provider business mailing address

PO BOX 627
SAFETY HARBOR FL
34695-0627
US

V. Phone/Fax

Practice location:
  • Phone: 727-791-8040
  • Fax: 727-791-8045
Mailing address:
  • Phone: 727-791-8040
  • Fax: 727-791-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: