Provider Demographics
NPI:1467518571
Name:STAYER, JAMIE LAYNE (ITDS)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE LAYNE
Middle Name:
Last Name:STAYER
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 DEANNA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-7846
Mailing Address - Country:US
Mailing Address - Phone:863-465-7156
Mailing Address - Fax:
Practice Address - Street 1:134 DEANNA DR
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-7846
Practice Address - Country:US
Practice Address - Phone:863-465-7156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL103TE1000X103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist