MEDICARE: DR. KARI ENG PSYD

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	PY9629	FL
2	103G00000X	Clinical Neuropsychologist	PY9629	FL

General Provider Information

NPI Number	:	1356591366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI ENG PSYD

Provider Business Mailing Address
First Line	:	4210 VALLEY RIDGE BLVD STE 113
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5171
Country	:	US
Telephone Number	:	904-303-8362
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 VALLEY RIDGE BLVD STE 113
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-5171
Country	:	US
Telephone Number	:	904-303-8362
Fax Number	:

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

Provider Enumeration Date	:	09/26/2008
Last Update Date	:	02/09/2023

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