Provider Demographics
NPI:1114098241
Name:PSYNCHRONY, INC
Entity Type:Organization
Organization Name:PSYNCHRONY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:NENOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:954-983-5330
Mailing Address - Street 1:14011 SW 33RD CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4683
Mailing Address - Country:US
Mailing Address - Phone:954-382-9690
Mailing Address - Fax:954-382-9690
Practice Address - Street 1:4700 SHERIDAN ST STE R
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3416
Practice Address - Country:US
Practice Address - Phone:954-983-5330
Practice Address - Fax:954-983-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88835261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health