Healthcare Provider Details

I. General information

NPI: 1609886696
Provider Name (Legal Business Name): DR. STEVEN P. DINGFELDER & ASSOC., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 ST. JOHNS MEDICAL PARK DR SUITE A
ST. AUGUSTINE FL
32086
US

IV. Provider business mailing address

9 ST. JOHNS MEDICAL PARK DR SUITE A
ST. AUGUSTINE FL
32086
US

V. Phone/Fax

Practice location:
  • Phone: 904-797-2705
  • Fax: 904-797-2820
Mailing address:
  • Phone: 904-797-2705
  • Fax: 904-797-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY3269
License Number StateFL

VIII. Authorized Official

Name: DR. STEVEN P DINGFELDER
Title or Position: OWNER/LICENSED PSYCHOLOGIST
Credential: PH.D.
Phone: 904-797-2705