Provider Demographics
NPI:1962588392
Name:LAIRD, NYAMEKYE (PHD)
Entity type:Individual
Prefix:DR
First Name:NYAMEKYE
Middle Name:
Last Name:LAIRD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 63RD AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-5824
Mailing Address - Country:US
Mailing Address - Phone:850-294-3691
Mailing Address - Fax:
Practice Address - Street 1:500 S FLORIDA AVE
Practice Address - Street 2:SUITE #210
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-5276
Practice Address - Country:US
Practice Address - Phone:863-687-1222
Practice Address - Fax:863-603-6546
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000690500Medicaid