Unknown Individual – Psychologist, NPI 1710910088

Unknown Individual is a healthcare provider. based in Davie, Florida. specializing in Psychologist. They hold a License No. PY 4511 (FL). The NPI Number for Unknown Individual is 1710910088

Main info

Organization
Inactive
46 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710910088
Phone
(954) 423-9911
Address
12565 ORANGE DR
Deactivation Date
18 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9544239911
Graduation Year
1980 (46 years ago)
PAC ID
3476813536
Professional Enrollment ID
I20180209000789
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Orange Drive, Davie, Broward County, Florida, 33328, United States

    #411

    DAVIE, FL 333304303

    Phone: (954) 423-9911

    Fax: (954) 423-4338

    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.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

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

No Medicare enrollment or revalidation data available for this provider in our database.

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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 33330)

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Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1710910088.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Psychologist. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Davie, Florida in the same public data insurers reference.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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