Provider Demographics
NPI:1154692002
Name:BYRD, STEPHANIE (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 COLUMBIA ST
Mailing Address - Street 2:800
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3454
Mailing Address - Country:US
Mailing Address - Phone:727-674-3593
Mailing Address - Fax:619-858-2383
Practice Address - Street 1:500 W HARBOR DR
Practice Address - Street 2:305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7715
Practice Address - Country:US
Practice Address - Phone:727-674-3593
Practice Address - Fax:619-858-2383
Is Sole Proprietor?:No
Enumeration Date:2012-01-24
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24265103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical