ANISSA MAFFETT (PHD) – Clinical Neuropsychologist, NPI 1689359010

ANISSA MAFFETT (PHD) is a healthcare provider. based in Jacksonville, Florida. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PHD. The NPI Number for ANISSA MAFFETT (PHD) is 1689359010

Main info

Female
Sole Proprietor
5 Years Of Experience
Accepts Medicare Assignment
Name
ANISSA MAFFETT (PHD)
NPI
1689359010
Phone
(904) 345-7251
Address
3901 UNIVERSITY BLVD S
Enumeration Date
21 June 2023
Last Update Date
21 June 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9048587606
Graduation Year
2021 (5 years ago)
PAC ID
3870949829
Group Practice PAC ID
4284664954
Professional Enrollment ID
I20231026002548
Address ID
FL322164312JA3901XSXXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:2State licenses:0Digital endpointsOther names

1,602 CLINICAL PSYCHOLOGIST in FL

Provider Addresses for ANISSA MAFFETT (PHD)

  • 3901 UNIVERSITY BLVD S

    JACKSONVILLE, FL 322164312

    Phone: (904) 345-7251

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2023-10-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20231026002548IClinical PsychologistFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32216)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4284664954View full group profile
NameSpecialtyState
Clinical PsychologistFL
Clinical PsychologistFL
Clinical PsychologistFL
Clinical PsychologistOR
-FL
Clinical PsychologistWI
Clinical PsychologistAL
Clinical PsychologistFL
-FL
-FL

Reviews

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Frequently asked questions

What number should I use to identify ANISSA MAFFETT (PHD) for billing?
Administrative and clinical systems typically use NPI 1689359010 for ANISSA MAFFETT (PHD).
Is ANISSA MAFFETT (PHD)'s NPI status active today?
Active status means ANISSA MAFFETT (PHD)'s NPI record is not deactivated in the public file.
What type of care does ANISSA MAFFETT (PHD) provide?
ANISSA MAFFETT (PHD)'s profile centers on Clinical Neuropsychologist. Clinical services aligned with this taxonomy classification.
What geographic area is tied to ANISSA MAFFETT (PHD)?
ANISSA MAFFETT (PHD) is associated with Jacksonville, Florida in the same public data insurers reference.
Why is information missing for ANISSA MAFFETT (PHD)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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