Provider Demographics
NPI:1154644540
Name:DEVERA, AISHA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AISHA
Middle Name:MARIE
Last Name:DEVERA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15577 IONA LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1851
Mailing Address - Country:US
Mailing Address - Phone:818-679-2023
Mailing Address - Fax:
Practice Address - Street 1:13039 W LINEBAUGH AVE
Practice Address - Street 2:BUILDING V, SUITE 101
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4451
Practice Address - Country:US
Practice Address - Phone:888-531-1313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8011103TC0700X
NVPY0619103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical