Ilyssa Hershey PSYD LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY6625 Issued in FL

Legal business name

ILYSSA HERSHEY PSYD LLC

Practice address

15757 Pines Blvd
PMB 311
Pembroke Pines, FL 33027-1207

Phone

(954) 849-2012

Fax

(954) 499-5913

NPI assigned

Oct 16, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ilyssa Hershey, PSYDNPI 1417211723

Title

Owner

Phone

(954) 849-2012

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ilyssa Hershey, PSYD

  • Clinical Psychologist
  • Coral Springs, FL
  • NPI 1417211723
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350345600000",
    "number": "1013260082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15757 PINES BLVD",
            "address_2": "PMB 311",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271207",
            "telephone_number": "954-849-2012",
            "fax_number": "954-499-5913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15757 PINES BLVD",
            "address_2": "PMB 311",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271207",
            "telephone_number": "954-849-2012",
            "fax_number": "954-499-5913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILYSSA HERSHEY PSYD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2012-10-16",
        "status": "A",
        "authorized_official_last_name": "HERSHEY",
        "authorized_official_first_name": "ILYSSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "954-849-2012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY6625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.