Active NPI
Stephanie L Nassar, PH.D.
- Rehabilitation Psychologist
- St Petersburg, FL
National Provider Identifier
1558764191
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- License
- PY 9624
- Practice address
- 140 Fountain Pkwy N Ste 600
St Petersburg, FL 33716-1274 - Phone
- (727) 575-8058
- NPI assigned
- Sep 26, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | PY 9624 | FL | Primary |
Addresses
Primary practice location
140 Fountain Pkwy N Ste 600
St Petersburg, FL 33716-1274
Mailing address
140 Fountain Pkwy N Ste 600
St Petersburg, FL 33716-1274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 9624 | FL | MD | Rehabilitation Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1634688000000",
"number": "1558764191",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 FOUNTAIN PKWY N STE 600",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337161274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 FOUNTAIN PKWY N STE 600",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337161274",
"telephone_number": "727-575-8058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NASSAR",
"first_name": "STEPHANIE",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-26",
"last_updated": "2021-10-20",
"certification_date": "2021-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": "FL",
"license": "PY 9624",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.