MEDICARE: VIJAYA SIDDALINGAPPA 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	103TC0700X	Clinical Psychologist	PY9731	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558595884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIJAYA SIDDALINGAPPA PH.D

Provider Business Mailing Address
First Line	:	400 N ASHLEY DR
Second Line	:	STE 1625
City	:	TAMPA
State	:	FL
Zip	:	33602-4300
Country	:	US
Telephone Number	:	813-289-6597
Fax Number	:	844-587-4802

Provider Business Practice Location Address
First Line	:	400 N ASHLEY DR
Second Line	:	STE 1625
City	:	TAMPA
State	:	FL
Zip	:	33602-4300
Country	:	US
Telephone Number	:	813-289-6597
Fax Number	:	844-587-4802

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

Provider Enumeration Date	:	05/14/2009
Last Update Date	:	02/16/2017

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