MEDICARE: MICHELLE DIEHL, PSY.D., R.N., PL

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	8005	FL

General Provider Information

NPI Number	:	1346578457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE DIEHL, PSY.D., R.N., PL

Provider Business Mailing Address
First Line	:	209 LITHIA PINECREST RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5307
Country	:	US
Telephone Number	:	813-957-2765
Fax Number	:	813-657-1049

Provider Business Practice Location Address
First Line	:	209 LITHIA PINECREST RD
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-5307
Country	:	US
Telephone Number	:	813-957-2765
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER/OWNER/PROVIDER
Name	:	MICHELLE-ANNE DIEHL
Credential	:	PSYD, RN
Telephone Number	:	813-957-2765

Provider Enumeration Date	:	12/01/2009
Last Update Date	:	06/04/2020

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