Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | PY 9624 | FL |
NPI | 1558764191 |
---|---|
Provider Name | Dr. Stephanie L Nassar |
First Address | St Petersburg, FL 33716-1274 |
Second Address | St Petersburg, FL 33716-1274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2014 |
Last Update Date | 20/10/2021 |