Provider Demographics
NPI:1326063090
Name:SUNTREE PSYCHIATRY INC
Entity Type:Organization
Organization Name:SUNTREE PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YANIK
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:LUIS-ROIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-751-7545
Mailing Address - Street 1:1331 BEDFORD DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1987
Mailing Address - Country:US
Mailing Address - Phone:321-751-7545
Mailing Address - Fax:321-751-0311
Practice Address - Street 1:1331 BEDFORD DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1987
Practice Address - Country:US
Practice Address - Phone:321-751-7545
Practice Address - Fax:321-751-0311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME627782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26899OtherBCBS
FL26899OtherBCBS
FL=========OtherTRICARE
FLF95903Medicare UPIN