Provider Demographics
NPI:1215031695
Name:FELDMAN, PAMELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:FELDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 NW15TH ST 216A
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1390
Mailing Address - Country:US
Mailing Address - Phone:561-385-9434
Mailing Address - Fax:561-338-8492
Practice Address - Street 1:1050NW15TH ST 216A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1390
Practice Address - Country:US
Practice Address - Phone:561-385-9434
Practice Address - Fax:561-338-8492
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59681YOtherPROVIDER #
FLS167636Medicare UPIN
S167636Medicare UPIN
77273Medicare ID - Type UnspecifiedGROUP