Provider Demographics
NPI:1578711719
Name:GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC
Other - Org Name:GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHZAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-974-9542
Mailing Address - Street 1:510 NW 98TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-1617
Mailing Address - Country:US
Mailing Address - Phone:954-822-2754
Mailing Address - Fax:954-822-2754
Practice Address - Street 1:9050 PINES BLVD STE 425-428
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6455
Practice Address - Country:US
Practice Address - Phone:954-822-2754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLA11138310400000X
363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living FacilityGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5000OtherMENTAL HEALTH
FL142787300Medicaid