Provider Demographics
NPI:1073289138
Name:DRYMOND, MIKAYLA JANAE (EDS)
Entity Type:Individual
Prefix:MISS
First Name:MIKAYLA
Middle Name:JANAE
Last Name:DRYMOND
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15915 WOODPOST PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1558
Mailing Address - Country:US
Mailing Address - Phone:315-534-9112
Mailing Address - Fax:
Practice Address - Street 1:111 S BOULEVARD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-1901
Practice Address - Country:US
Practice Address - Phone:315-534-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent