Provider Demographics
NPI:1215284856
Name:BUTT, SAKINA MYKEA (PSYD, ABPP-CN)
Entity type:Individual
Prefix:DR
First Name:SAKINA
Middle Name:MYKEA
Last Name:BUTT
Suffix:
Gender:F
Credentials:PSYD, ABPP-CN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 863297
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-3297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:880 6TH ST S STE 420
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4825
Practice Address - Country:US
Practice Address - Phone:727-767-8477
Practice Address - Fax:727-767-8244
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8544103G00000X, 103G00000X
FLPY8544103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGZ296ZMedicare PIN