MEDICARE: DR. SANDRA KAY BEATY PH.D.

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	PY7066	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	75328	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1225083777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA KAY BEATY PH.D.

Provider Business Mailing Address
First Line	:	1551 N. FLAGLER DR.
Second Line	:	#710
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3441
Country	:	US
Telephone Number	:	561-655-6587
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 N FLAGLER DR
Second Line	:	#710
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3438
Country	:	US
Telephone Number	:	561-655-6587
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	07/21/2022

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