MEDICARE: FLORIDA PSYCH SERVICES INC.

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	103TP0016X	Prescribing (Medical) Psychologist

General Provider Information

NPI Number	:	1356795629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PSYCH SERVICES INC.

Provider Business Mailing Address
First Line	:	13436 SW PEMBROKE CIR N
Second Line	:
City	:	LAKE SUZY
State	:	FL
Zip	:	34269-6909
Country	:	US
Telephone Number	:	239-478-7984
Fax Number	:

Provider Business Practice Location Address
First Line	:	13436 SW PEMBROKE CIR N
Second Line	:
City	:	LAKE SUZY
State	:	FL
Zip	:	34269-6909
Country	:	US
Telephone Number	:	239-478-7984
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	COLLEEN SCUDDER
Credential	:
Telephone Number	:	239-478-7984

Provider Enumeration Date	:	04/22/2016
Last Update Date	:	04/22/2016

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