Individual
MATTHEW MICELI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
146 2ND ST N STE 305, ST PETERSBURG, FL 33701-3361
(727) 289-6583
Mailing address
146 2ND ST N STE 305, SAINT PETERSBURG, FL 33701-3361
(727) 289-6583
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PY11206
FLORIDA DEPARTMENT OF HEALTH
FL
Enumeration date
10/06/2021
Last updated
10/06/2021
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