Provider Demographics
NPI:1164788584
Name:A SHARED VISION
Entity Type:Organization
Organization Name:A SHARED VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PANDO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-567-1155
Mailing Address - Street 1:3400 CORAL WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3053
Mailing Address - Country:US
Mailing Address - Phone:305-567-1155
Mailing Address - Fax:305-448-6915
Practice Address - Street 1:3400 CORAL WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3053
Practice Address - Country:US
Practice Address - Phone:305-567-1155
Practice Address - Fax:305-448-6915
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:A SHARED VISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty