Provider Demographics
NPI:1023083698
Name:SHEALY, SUZANNE E (PHD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:E
Last Name:SHEALY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:MENTAL HEALTH AND BEHAVIORAL SCIENCE (116A)
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-631-7135
Mailing Address - Fax:813-631-7129
Practice Address - Street 1:13000 BRUCE B DOWNS BLVD
Practice Address - Street 2:PSYCHOLOGY (116B)
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-4745
Practice Address - Country:US
Practice Address - Phone:813-631-7135
Practice Address - Fax:813-631-7129
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical