Provider Demographics
NPI:1225212517
Name:DIANE A MCKAY PSY D PA
Entity Type:Organization
Organization Name:DIANE A MCKAY PSY D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:941-365-7240
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:TALLEVAST
Mailing Address - State:FL
Mailing Address - Zip Code:34270-0903
Mailing Address - Country:US
Mailing Address - Phone:941-365-7240
Mailing Address - Fax:
Practice Address - Street 1:1990 MAIN ST
Practice Address - Street 2:SUITE 750
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5955
Practice Address - Country:US
Practice Address - Phone:941-365-7240
Practice Address - Fax:941-309-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4085Medicare PIN