Provider Demographics
NPI:1013989433
Name:MCKAY, DIANE A (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:A
Last Name:MCKAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:TALLEVAST
Mailing Address - State:FL
Mailing Address - Zip Code:34270-0903
Mailing Address - Country:US
Mailing Address - Phone:941-365-7240
Mailing Address - Fax:941-365-7230
Practice Address - Street 1:1990 MAIN ST
Practice Address - Street 2:SUITE 750
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5955
Practice Address - Country:US
Practice Address - Phone:941-365-7240
Practice Address - Fax:941-309-5184
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6237103TC0700X, 103TB0200X, 103TC2200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54681OtherBCBS PROVIDER #
FL54681OtherBCBS PROVIDER #
FLE4836YMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
FLK4085Medicare ID - Type UnspecifiedGROUP PAYEE CODE