Healthcare Provider Details

I. General information

NPI: 1760560304
Provider Name (Legal Business Name): JOAN M DIGREGORIO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 NW 88TH AVE
SUNRISE FL
33351-6637
US

IV. Provider business mailing address

6245 N FEDERAL HWY SUITE 300
FT LAUDERDALE FL
33308-1998
US

V. Phone/Fax

Practice location:
  • Phone: 954-797-7881
  • Fax: 954-797-7880
Mailing address:
  • Phone: 954-956-1966
  • Fax: 954-745-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY0004299
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY0004299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: