Provider Demographics
NPI:1467541144
Name:SAND DOLLAR PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:SAND DOLLAR PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-226-7100
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32540-1648
Mailing Address - Country:US
Mailing Address - Phone:850-226-7100
Mailing Address - Fax:
Practice Address - Street 1:137 CRYSTAL BEACH DR STE 137-C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3569
Practice Address - Country:US
Practice Address - Phone:850-226-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57629OtherBCBS FL
FL57629OtherBCBS FL
FL57629ZMedicare ID - Type Unspecified