| Organization Name: | ILYSSA HERSHEY PSYD LLC |
| NPI Number: | 1013260082 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ILYSSA HERSHEY (OWNER) |
| Mailing Address: | 15757 Pines Blvd Pmb 311 Pembroke Pines |
| State: | FL US |
| Postal Code: | 330271207 |
| Phone Number: | 9548492012 |
| Fax Number: | 9544995913 |
| NPI Enumeration Date: | 10/16/2012 |
| NPI Last Update Date: | 10/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PY6625 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |