Healthcare Provider Details

I. General information

NPI: 1043431182
Provider Name (Legal Business Name): MICHAEL D HEALY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 N ORANGE AVE STE 102
SARASOTA FL
34236-8531
US

IV. Provider business mailing address

235 N ORANGE AVE STE 102
SARASOTA FL
34236-8531
US

V. Phone/Fax

Practice location:
  • Phone: 941-923-9533
  • Fax:
Mailing address:
  • Phone: 941-923-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License NumberPY0004579
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: