DR. SALLY STADER PH.D.
NPI 1639397169
Psychologist in Lakeland, FL

Active since April 22, 2007Opted out of Medicare · through Oct 1, 2027
4404 S.FLORIDA AVE., SUITE #3, LAKELAND, FL 33813(863) 247-2626 Get Directions Write a Review

NPPES record last updated: December 10, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Dr. Sally Stader Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SALLY STADER PH.D. (NPI 1639397169) is an individual psychologist in Lakeland, Florida, licensed in Florida (PY5379) and active in the NPI registry since April 2007. She has opted out of Medicare through October 1, 2027 and remains eligible to order and refer.

NPPES Registry Identity

NPI1639397169
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. SALLY STADERCredential: PH.D.
Location Address4404 S.FLORIDA AVE., SUITE #3Lakeland, FL 33813-2169
Mailing Address4404 S Florida Ave Ste 3Lakeland, FL 33813-2183 · (863) 247-2626
Sole ProprietorNo
Enumeration DateApril 22, 2007
Last NPPES UpdateDecember 10, 2022
NPPES CertifiedDecember 10, 2022
NPI 1639397169 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
Licenses Licensed in FL · PY5379 Licensed in IN · 20040657A
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
4404 S.FLORIDA AVE., Lakeland, FL 33813

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Dr. Sally Stader Ph.d. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from October 1, 2015 through October 1, 2027.

Opt-Out Effective DateOctober 1, 2015
Opt-Out In Effect ThroughOctober 1, 2027Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sally Stader's NPI number?

The NPI number for Sally Stader is 1639397169. It was assigned to this individual provider in the NPPES registry on April 22, 2007.

Where is Sally Stader located?

Sally Stader practices at 4404 S.Florida Ave. Suite #3, Lakeland, FL 33813. The listed phone number is (863) 247-2626.

What is Sally Stader's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Sally Stader enrolled in Medicare?

No. Sally Stader has opted out of Medicare through October 1, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

What insurance does Sally Stader accept?

Health plans from Florida Blue (BlueCross BlueShield FL) and Florida Blue HMO (a BlueCross BlueShield FL company) list Sally Stader as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sally Stader was last updated on December 10, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.