Provider Demographics
NPI:1558632117
Name:PATRICIA L THOMAS SHUTT PSYD LLC
Entity Type:Organization
Organization Name:PATRICIA L THOMAS SHUTT PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L THOMAS
Authorized Official - Last Name:SHUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-266-8866
Mailing Address - Street 1:120 SE 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 SE 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483
Practice Address - Country:US
Practice Address - Phone:561-266-8866
Practice Address - Fax:561-266-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54841Medicare PIN