Provider Demographics
NPI:1376712166
Name:RUNSDORF, MYLES ALAN (PSYD)
Entity Type:Individual
Prefix:
First Name:MYLES
Middle Name:ALAN
Last Name:RUNSDORF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 GLADES RD
Mailing Address - Street 2:SUITE #208
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3988
Mailing Address - Country:US
Mailing Address - Phone:561-362-9030
Mailing Address - Fax:561-362-9040
Practice Address - Street 1:9325 GLADES RD
Practice Address - Street 2:SUITE #208
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3988
Practice Address - Country:US
Practice Address - Phone:561-362-9030
Practice Address - Fax:561-362-9040
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5801103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist