Provider Demographics
NPI:1811340805
Name:CESSNA PALAS, JULIE (PHD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:CESSNA PALAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:CESSNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:13000 BRUCE B DOWNS BLVD
Mailing Address - Street 2:116A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-4745
Mailing Address - Country:US
Mailing Address - Phone:813-972-2000
Mailing Address - Fax:813-903-4814
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-3562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10342103G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist