Basic Information
| Provider Information | |||||||||
| NPI: | 1821239880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWMAN | ||||||||
| FirstName: | JACLYN | ||||||||
| MiddleName: | WADDEY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WADDEY | ||||||||
| OtherFirstName: | JACLYN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1100 CLEARWATER LARGO ROAD | ||||||||
| Address2: | FLORIDA BEHAVIORAL INSTITUTE, PLC | ||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275186444 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1100 CLEARWATER LARGO ROAD | ||||||||
| Address2: | FBI, PLC | ||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234396283 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2009 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | ME 121294 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.