Provider Demographics
NPI:1134293343
Name:JOHN HENDERSHOT, PH.D., P.A.
Entity type:Organization
Organization Name:JOHN HENDERSHOT, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDERSHOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-265-4811
Mailing Address - Street 1:5221 EHRLICH RD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2006
Mailing Address - Country:US
Mailing Address - Phone:813-265-4811
Mailing Address - Fax:813-277-0202
Practice Address - Street 1:5221 EHRLICH RD
Practice Address - Street 2:SUITE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2006
Practice Address - Country:US
Practice Address - Phone:813-265-4811
Practice Address - Fax:813-277-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4314103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty