Timothy T. Wysocki, PHD

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

PY4811 Issued in FL

Practice address

807 Childrens Way
Jacksonville, FL 32207-8426

Phone

(904) 390-3785

Fax

(904) 390-3512

NPI assigned

Aug 10, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314921600000",
    "number": "1205847738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "address_2": "PROVIDER ENROLLMENT DEPT",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-6212",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 CHILDRENS WAY",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078426",
            "telephone_number": "904-390-3785",
            "fax_number": "904-390-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSOCKI",
        "first_name": "TIMOTHY",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2011-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY4811",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "FL",
            "license": "PY4811",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000546202A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Wynn, M.S.
• Gregory Carl Wynn, M.D.
• Lindsay Michele Wynn, DPM
• Natalie Alicia Wynn, CRNA
• Ashley Wynne
• Ewa M Wysokinska, M.D.
• Ashley Wysong, M.D.
• Daniel S Wyzan, MD
• Sydney Xhafellari, OTD, OTR
• Ilva Xhemali, PHARMD

• Clinical Child & Adolescent Psychologist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Clinical Child & Adolescent Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.