Provider Demographics
NPI:1194043547
Name:CONRAD, NYDIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NYDIA
Middle Name:
Last Name:CONRAD
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 1:601 S HARBOUR ISLAND BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5927
Mailing Address - Country:US
Mailing Address - Phone:813-480-6427
Mailing Address - Fax:
Practice Address - Street 1:3737 MARYWEATHER LN
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7779
Practice Address - Country:US
Practice Address - Phone:813-480-6427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8091103TC0700X
FL8091103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical