Provider Demographics
NPI:1982948337
Name:PSYCHDYNAMICS, P.A.
Entity type:Organization
Organization Name:PSYCHDYNAMICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERSHBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-359-5709
Mailing Address - Street 1:1209 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-4113
Mailing Address - Country:US
Mailing Address - Phone:352-376-4111
Mailing Address - Fax:352-376-4122
Practice Address - Street 1:1209 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-4113
Practice Address - Country:US
Practice Address - Phone:352-376-4111
Practice Address - Fax:352-376-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-23
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00552962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063304600Medicaid
FLE56541Medicare UPIN