Provider Demographics
NPI:1033129804
Name:TODOROFF, GERALD LEE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
Last Name:TODOROFF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5327 COMMERCIAL WAY
Mailing Address - Street 2:C 115
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1448
Mailing Address - Country:US
Mailing Address - Phone:352-597-5497
Mailing Address - Fax:352-597-1662
Practice Address - Street 1:5327 COMMERCIAL WAY
Practice Address - Street 2:C 115
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1448
Practice Address - Country:US
Practice Address - Phone:352-597-5497
Practice Address - Fax:352-597-1662
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD3030103T00000X
FLPY5565103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54115Medicare ID - Type Unspecified
FL537931Medicare UPIN