| Ilyssa Hershey Psyd Llc | |
|
15757 Pines Blvd Pmb 311 Pembroke Pines FL 33027-1207 | |
| (954) 849-2012 | |
| (954) 499-5913 |
| Full Name | Ilyssa Hershey Psyd Llc |
|---|---|
| Speciality | Psychologist |
| Location | 15757 Pines Blvd, Pembroke Pines, Florida |
| Authorized Official Name and Position | Ilyssa Hershey (OWNER) |
| Authorized Official Contact | 9548492012 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ilyssa Hershey Psyd Llc 15757 Pines Blvd Pmb 311 Pembroke Pines FL 33027-1207 Ph: (954) 849-2012 | Ilyssa Hershey Psyd Llc 15757 Pines Blvd Pmb 311 Pembroke Pines FL 33027-1207 Ph: (954) 849-2012 |
| NPI Number | 1013260082 |
|---|---|
| Provider Enumeration Date | 10/16/2012 |
| Last Update Date | 10/16/2012 |
| Medicare PECOS PAC ID | 4082867627 |
|---|---|
| Medicare Enrollment ID | O20130110000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013260082 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PY6625 (Florida) | Primary |
| Provider Name | Ilyssa M Hershey |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417211723 PECOS PAC ID: 7618120155 Enrollment ID: I20130110000586 |
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