Sally Stader, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PY5379 Issued in FL

Practice address

4404 S.Florida Ave.
Suite #3
Lakeland, FL 33813-2169

Phone

(863) 247-2626

NPI assigned

Apr 22, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2015 through Oct 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bettye West & Associates, Inc.

  • Mental Health Counselor
  • Lakeland, FL
  • NPI 1063605111
  NPD (past)

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

{
    "created_epoch": "1177200000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670630400000",
    "number": "1639397169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4404 S FLORIDA AVE STE 3",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132183",
            "telephone_number": "863-247-2626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4404 S.FLORIDA AVE.",
            "address_2": "SUITE #3",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338132169",
            "telephone_number": "863-247-2626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STADER",
        "first_name": "SALLY",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-22",
        "last_updated": "2022-12-10",
        "certification_date": "2022-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040657A",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY5379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SS Polk III Community HC LLC
• Melidza St Cyr, CRNA
• St Lukes Regional Health Care PLC
• Donna M St. Rock, MA
• Ludmyla J. Staddon, ARNP
• Stages Health & Wellness, LLC
• Daniel Jacob Stahl, BSA
• Heather Stambaugh
• Heather R Stamper, PHARMD
• Mark Raymond Stampfl, MD

• Psychologist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.