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NPI Code Detail

MEDICARE: JOHN HENDERSHOT PH.D.

MEDICARE: JOHN HENDERSHOT 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
1103TC0700XClinical PsychologistPY4314FL

General Provider Information

NPI Number : 1386813376
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN HENDERSHOT PH.D.
Provider Business Mailing Address
First Line : 14502 N DALE MABRY HWY STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33618-2040
Country : US
Telephone Number : 813-265-4811
Fax Number :
Provider Business Practice Location Address
First Line : 14502 N DALE MABRY HWY STE 200
Second Line :
City : TAMPA
State : FL
Zip : 33618-2040
Country : US
Telephone Number : 813-265-4811
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2008
Last Update Date : 07/21/2023

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