Provider Demographics
NPI:1821239880
Name:NEWMAN, JACLYN WADDEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:WADDEY
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JACLYN
Other - Middle Name:MARIE
Other - Last Name:WADDEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1100 CLEARWATER LARGO ROAD
Mailing Address - Street 2:FLORIDA BEHAVIORAL INSTITUTE, PLC
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770
Mailing Address - Country:US
Mailing Address - Phone:727-518-6444
Mailing Address - Fax:
Practice Address - Street 1:1100 CLEARWATER LARGO ROAD
Practice Address - Street 2:FBI, PLC
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:423-439-6283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1212942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry