Individual
DR. TIESHA SIMONA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
8360 W OAKLAND PARK BLVD STE 303, SUNRISE, FL 33351-7339
(954) 546-4677
(941) 328-3575
Mailing address
8360 W OAKLAND PARK BLVD STE 303, SUNRISE, FL 33351-7339
(954) 546-4677
(954) 246-4996
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY 7781
FL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
PY7781
FL
103TC0700X
Clinical Psychologist
PY7781
FL
103TF0200X
Forensic Psychologist
PY7781
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106660500
—
FL
Enumeration date
01/07/2009
Last updated
01/06/2022
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