Individual
POONAM ISHANPARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
6845 E US HIGHWAY 36 STE 500, AVON, IN 46123-9781
(813) 289-6597
(813) 289-6592
Mailing address
6845 E US HIGHWAY 36 STE 500, AVON, IN 46123-9781
(317) 742-1340
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20042843A
IN
103T00000X
Psychologist
PY9504
FL
103T00000X
Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
20042843A
IN
103TC0700X
Clinical Psychologist
20042843A
IN
Other
Enumeration date
01/16/2015
Last updated
11/03/2024
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