| |
320 N Cattlemen Rd Apt 103 Sarasota FL 34232-6434 | |
(941) 564-9478 | |
Not Available |
Full Name | |
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Speciality | Psychologist |
Location | 320 N Cattlemen Rd Apt 103, Sarasota, Florida |
Authorized Official Name and Position | Magdalena Fudyma (PRESIDENT) |
Authorized Official Contact | 9415649478 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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320 N Cattlemen Rd Apt 103 Sarasota FL 34232-6434 Ph: (941) 564-9478 | 320 N Cattlemen Rd Apt 103 Sarasota FL 34232-6434 Ph: (941) 564-9478 |
NPI Number | 1366106908 |
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Provider Enumeration Date | 10/29/2021 |
Last Update Date | 01/26/2022 |
Certification Date | 01/26/2022 |
Medicare PECOS PAC ID | 7012381684 |
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Medicare Enrollment ID | O20230323001370 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366106908 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103T00000X | Psychologist | (* (Not Available)) | Primary |
Provider Name | Magdalena Fudyma |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1073988671 PECOS PAC ID: 3971917279 Enrollment ID: I20210812000581 |
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