Provider Demographics
NPI:1992030290
Name:PATENAUDE, AMY HEATH SHARP (MA, EDS)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:HEATH SHARP
Last Name:PATENAUDE
Suffix:
Gender:F
Credentials:MA, EDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:HEATH
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2908 W ANGELES ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6002
Mailing Address - Country:US
Mailing Address - Phone:813-482-7928
Mailing Address - Fax:
Practice Address - Street 1:2908 W ANGELES ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6002
Practice Address - Country:US
Practice Address - Phone:813-482-7928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
FLSS1189103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist