Provider Demographics
NPI:1447425137
Name:WISEMAN, RACHEL JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:JOY
Last Name:WISEMAN
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 1:3800 S TAMIAMI TRL UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6909
Mailing Address - Country:US
Mailing Address - Phone:941-366-1693
Mailing Address - Fax:941-922-7574
Practice Address - Street 1:3800 S TAMIAMI TRL UNIT 210
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6909
Practice Address - Country:US
Practice Address - Phone:941-366-1693
Practice Address - Fax:941-922-7574
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7703103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist