Provider Demographics
NPI:1750689725
Name:ISAACS, MALINDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MALINDA
Middle Name:
Last Name:ISAACS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:MARTIN SUDDUTH
Other - Last Name:ISAACS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1090 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-9116
Mailing Address - Country:US
Mailing Address - Phone:941-363-0878
Mailing Address - Fax:859-963-1721
Practice Address - Street 1:1090 S TAMIAMI TRL STE 215
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-9116
Practice Address - Country:US
Practice Address - Phone:941-363-0878
Practice Address - Fax:859-963-1721
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY1569103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK128721Medicare UPIN