Provider Demographics
NPI:1417154055
Name:DERIS ATASSI, SANDRA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:DERIS ATASSI
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 1:6108 NW 113TH PL
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-3607
Mailing Address - Country:US
Mailing Address - Phone:305-213-2842
Mailing Address - Fax:305-597-0119
Practice Address - Street 1:8333 NW 53RD ST STE 450
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-4837
Practice Address - Country:US
Practice Address - Phone:305-213-2842
Practice Address - Fax:305-597-0119
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7335103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical