MEDICARE: DR. TIFFANY EVE VASTARDIS 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	101YM0800X	Mental Health Counselor	MH20180	FL

General Provider Information

NPI Number	:	1275120271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANY EVE VASTARDIS PH.D.

Provider Business Mailing Address
First Line	:	5510 SW 44TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33314-6720
Country	:	US
Telephone Number	:	954-326-2795
Fax Number	:

Provider Business Practice Location Address
First Line	:	6410 SW 57TH ST
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33314-7106
Country	:	US
Telephone Number	:	954-326-2795
Fax Number	:

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

Provider Enumeration Date	:	12/23/2020
Last Update Date	:	05/04/2026

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