Provider Demographics
NPI:1457532764
Name:SALEH-MOHD, ISRA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ISRA
Middle Name:M
Last Name:SALEH-MOHD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 BALLY MONEY RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-8067
Mailing Address - Country:US
Mailing Address - Phone:813-541-9096
Mailing Address - Fax:813-319-3933
Practice Address - Street 1:18958 DALE MABRY HWY N
Practice Address - Street 2:SUITE102
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4911
Practice Address - Country:US
Practice Address - Phone:813-541-9096
Practice Address - Fax:813-319-3933
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7588103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical