=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740323260
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBORAH MELES SACKS PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2007
-----------------------------------------------------
Last Update Date | 05/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5648 SEMOLINO ST
-----------------------------------------------------
City | NOKOMIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-716-1000
-----------------------------------------------------
Fax | 856-354-0681
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5648 SEMOLINO ST
-----------------------------------------------------
City | NOKOMIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34275
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-716-1000
-----------------------------------------------------
Fax | 856-354-0681
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 35SI00 230800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------