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General NPI Number Information
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NPI Number | 1285406199
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Entity Type | Organization
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Legal Business Name | SUNLIFE PSYCHOLOGY
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Dates
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Enumeration Date | 10/24/2023
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 3550 BISCAYNE BLVD STE 305
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City | MIAMI
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State | FL
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Zip | 33137-3853
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Country | US
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Telephone | 646-942-1531
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Fax |
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Provider Business Mailing Address
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Address Line | 558154 LUDLAM STATION
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City | MIAMI
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State | FL
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Zip | 33255
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Country | US
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Telephone | 305-859-1709
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. SAM KEDEM
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Credential | PHD
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Telephone | 646-942-1531
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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 |
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License Number State |
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