MEDICARE: GRACE HUI-YI CHANG PHD

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	103TC0700X	Clinical Psychologist	0810004275	VA
2	103TC0700X	Clinical Psychologist	PY12772	FL

General Provider Information

NPI Number	:	1184567117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE HUI-YI CHANG PHD

Provider Business Mailing Address
First Line	:	3615 49TH ST N # 245
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33710-2151
Country	:	US
Telephone Number	:	304-389-3561
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 15TH AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-5229
Country	:	US
Telephone Number	:	304-389-3561
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ GRACE HUI-YI CHANG PHD” Practice Location

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