NPIMap

Organization Active NPI

Bayshore Psychological Services

  • Psychologist
  • Lithia, FL
National Provider Identifier
1750798567
Registry record updated Jul 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PY8123 Issued in FL
Legal business name
BAYSHORE PSYCHOLOGICAL SERVICES
Practice address
15525 Starling Crossing Dr
Lithia, FL 33547-4021
Phone
(813) 351-9235
NPI assigned
Jul 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2014

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

Authorized official

Name
Dr. Robert Klukoff, PSY.D.NPI 1104130335
Title
Psychologist
Phone
(813) 351-9235

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X PY8123 FL Primary

Addresses

Primary practice location

15525 Starling Crossing Dr
Lithia, FL 33547-4021

Mailing address

15525 Starling Crossing Dr
Lithia, FL 33547-4021
Phone (813) 351-9235

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405296000000",
    "number": "1750798567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15525 STARLING CROSSING DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474021",
            "telephone_number": "813-351-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15525 STARLING CROSSING DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474021",
            "telephone_number": "813-351-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSHORE PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-14",
        "last_updated": "2014-07-14",
        "status": "A",
        "authorized_official_last_name": "KLUKOFF",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "813-351-9235",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY8123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithia, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2014; 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.