Healthcare Provider Details

I. General information

NPI: 1659485597
Provider Name (Legal Business Name): SAUNDRA STOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BRUCE B DOWNS BLVD MDC 14
TAMPA FL
33612-4742
US

IV. Provider business mailing address

3515 E FLETCHER AVE
TAMPA FL
33613-4706
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-8900
  • Fax:
Mailing address:
  • Phone: 813-974-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME69922
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: