Healthcare Provider Details

I. General information

NPI: 1548592199
Provider Name (Legal Business Name): KYLE RICHARD CIEPLY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 CATTLEMEN RD STE 204
SARASOTA FL
34232-6212
US

IV. Provider business mailing address

5616 GOODPASTURE GLN
BRADENTON FL
34211-4000
US

V. Phone/Fax

Practice location:
  • Phone: 941-326-3223
  • Fax:
Mailing address:
  • Phone: 941-929-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: