Provider Demographics
NPI:1962430892
Name:STEIN, WAYNE S (PSYD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:S
Last Name:STEIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4280
Mailing Address - Country:US
Mailing Address - Phone:321-724-9900
Mailing Address - Fax:321-724-6609
Practice Address - Street 1:408 5TH AVE
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4280
Practice Address - Country:US
Practice Address - Phone:321-724-9900
Practice Address - Fax:321-724-6609
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73691Medicare ID - Type UnspecifiedMC ID #