Diane M Vendryes, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY7359 Issued in FL

Practice address

4719 Highway 90
Marianna, FL 32446-7839

Phone

(850) 526-3314

Fax

(850) 526-5022

NPI assigned

May 2, 2008

Sex

Female

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1871769596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4719 HIGHWAY 90",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324467839",
            "telephone_number": "850-526-3314",
            "fax_number": "850-526-5022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4719 HIGHWAY 90",
            "city": "MARIANNA",
            "state": "FL",
            "postal_code": "324467839",
            "telephone_number": "850-526-3314",
            "fax_number": "850-526-5022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "951 Prim Ave Ste 20",
            "address_purpose": "LOCATION",
            "city": "Graceville",
            "state": "FL",
            "postal_code": "324402500",
            "country_code": "US",
            "telephone_number": "850-360-4000",
            "fax_number": "850-759-4100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VENDRYES",
        "first_name": "DIANE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-05-02",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY003128",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Marianna, FL
• Providers in Marianna, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.

Verify at the official NPI Registry.