Active NPI
Antoinette C Defazio, PH.D
- Psychologist
- Tampa, FL
National Provider Identifier
1851478382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY6666
- Practice address
- 6 Tampa General Cir
Tampa, FL 33606-3571 - Phone
- (813) 844-3541
- NPI assigned
- Nov 1, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 1613 | MD | |
| Clinical Neuropsychologist | 103G00000X | PY6666 | FL | |
| Psychologist | 103T00000X | PY6666 | FL | Primary |
Addresses
Primary practice location
6 Tampa General Cir
Tampa, FL 33606-3571
Mailing address
PO Box 1289
Tampa, FL 33601-1289
Phone (813) 835-8069
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1613 | Other | MD | PSYCHOLOGY LICENSE |
| PY 6666 | Other | FL | FLORIDA PSYCHOLOGY |
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 |
|---|---|---|---|
| 1613 | MD | MD | Clinical Neuropsychologist |
| PY6666 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1373241600000",
"number": "1851478382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1289",
"city": "TAMPA",
"state": "FL",
"postal_code": "336011289",
"telephone_number": "813-835-8069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 TAMPA GENERAL CIR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336063571",
"telephone_number": "813-844-3541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEFAZIO",
"first_name": "ANTOINETTE",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2013-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "MD",
"license": "1613",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "FL",
"license": "PY6666",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY6666",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PSYCHOLOGY LICENSE",
"identifier": "1613",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FLORIDA PSYCHOLOGY",
"identifier": "PY 6666",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.