Provider Demographics
NPI:1043431182
Name:HEALY, MICHAEL D (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:HEALY
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 1:235 N ORANGE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8531
Mailing Address - Country:US
Mailing Address - Phone:941-923-9533
Mailing Address - Fax:
Practice Address - Street 1:235 N ORANGE AVE STE 102
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8531
Practice Address - Country:US
Practice Address - Phone:941-923-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY00045792084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73850OtherBCBS
FLN239426OtherSTAYWELL/WELLCARE/HEALTHE
FLN239426OtherSTAYWELL/WELLCARE/HEALTHE