Healthcare Provider Details

I. General information

NPI: 1639338197
Provider Name (Legal Business Name): AGNIESZKA WASZCZUK MARSHALL PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E OCEAN BLVD SUITE 250-F
STUART FL
34994
US

IV. Provider business mailing address

900 E. OCEAN BOULEVARD, SUITE 250-F
STUART FL
34994
US

V. Phone/Fax

Practice location:
  • Phone: 772-242-9950
  • Fax: 772-220-3484
Mailing address:
  • Phone: 772-242-9950
  • Fax: 772-220-3484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: