MEDICARE: KRISTEN M STURDEVANT PSYD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY8738	FL

General Provider Information

NPI Number	:	1063833119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRISTEN M STURDEVANT PSYD PA

Provider Business Mailing Address
First Line	:	PO BOX 49284
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33743-9284
Country	:	US
Telephone Number	:	727-209-7792
Fax Number	:

Provider Business Practice Location Address
First Line	:	6251 PARK BLVD N STE 9B
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-3238
Country	:	US
Telephone Number	:	727-209-7792
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST/OWNER
Name	:	DR. KRISTEN M STURDEVANT
Credential	:	PSYD
Telephone Number	:	727-209-7792

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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