Provider Demographics
NPI:1649543208
Name:STRYCHARZ, STANISLAW J (PSYD)
Entity type:Individual
Prefix:DR
First Name:STANISLAW
Middle Name:J
Last Name:STRYCHARZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26811 S BAY DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4394
Mailing Address - Country:US
Mailing Address - Phone:239-992-4300
Mailing Address - Fax:239-495-9424
Practice Address - Street 1:26811 S BAY DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4394
Practice Address - Country:US
Practice Address - Phone:239-992-4300
Practice Address - Fax:239-495-9424
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
FLPY8341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist