Provider Demographics
NPI:1679537625
Name:THEYE, FRED WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:WILLIAM
Last Name:THEYE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13416 HARBOUR RIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-4814
Mailing Address - Country:US
Mailing Address - Phone:772-344-6456
Mailing Address - Fax:
Practice Address - Street 1:13416 HARBOUR RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-4814
Practice Address - Country:US
Practice Address - Phone:772-644-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6904103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist