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General NPI Number Information
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NPI Number | 1225212517
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Entity Type | Organization
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Legal Business Name | DIANE A MCKAY PSY D PA
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 1990 MAIN ST SUITE 750
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City | SARASOTA
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State | FL
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Zip | 34236-5955
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Country | US
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Telephone | 941-365-7240
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Fax | 941-309-5184
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Provider Business Mailing Address
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Address Line | PO BOX 903
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City | TALLEVAST
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State | FL
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Zip | 34270-0903
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Country | US
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Telephone | 941-365-7240
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIANE A MCKAY
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Credential | PSY D
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Telephone | 941-365-7240
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY6237
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License Number State | FL
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