Provider Demographics
NPI:1548441678
Name:ROSS, RHONDA MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:MICHELLE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1777 TAMIAMI TRL STE 403
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-4001
Mailing Address - Country:US
Mailing Address - Phone:941-488-5500
Mailing Address - Fax:888-505-3789
Practice Address - Street 1:1777 TAMIAMI TRL STE 403
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4001
Practice Address - Country:US
Practice Address - Phone:941-488-5500
Practice Address - Fax:888-505-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1133103G00000X, 103TC0700X, 103TR0400X, 103TR0400X
FLPY7611103T00000X, 103TA0700X, 103TC0700X, 103TR0400X, 103TF0200X, 103TH0100X, 103G00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service