Individual
DR. KISHA NICOLE BAZELAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
7901 4TH ST N # 8939, ST PETERSBURG, FL 33702-4305
(305) 676-7347
Mailing address
9621 W ELM LN, MIRAMAR, FL 33025-2328
(347) 743-4392
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
020128
NY
103TC1900X
Counseling Psychologist
020128
NY
103TC1900X
Counseling Psychologist
Primary
PY9272
FL
Other
Enumeration date
05/29/2013
Last updated
05/30/2025
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