Provider Demographics
NPI:1134130768
Name:PSYCHIATRIC GROUP OF ORLANDO PA
Entity Type:Organization
Organization Name:PSYCHIATRIC GROUP OF ORLANDO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:EL MENSHAWI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-733-4314
Mailing Address - Street 1:2749 RAINBOW SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7783
Mailing Address - Country:US
Mailing Address - Phone:407-275-0745
Mailing Address - Fax:407-275-0829
Practice Address - Street 1:422 SOUTH ALAFAYA TRAIL SUITE 17
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:407-275-0745
Practice Address - Fax:407-275-0829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME850572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5634AMedicare ID - Type UnspecifiedGROUP#