=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649565995
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARMON SEARS PSYD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2011
-----------------------------------------------------
Last Update Date | 11/14/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1700 S TAMIAMI TRL
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-677-0332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5317 FRUITVILLE RD UNIT 167
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34232-6402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-677-0332
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. KARMON SEARS
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 941-677-0332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PY7535
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------