Provider Demographics
NPI:1679856199
Name:FLORIDA PSYCHIATRIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:FLORIDA PSYCHIATRIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:FATIMA
Authorized Official - Last Name:MIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-342-3709
Mailing Address - Street 1:PO BOX 940953
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0953
Mailing Address - Country:US
Mailing Address - Phone:407-969-5633
Mailing Address - Fax:407-960-5635
Practice Address - Street 1:166 LOOKOUT PL
Practice Address - Street 2:SUITE 100
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4496
Practice Address - Country:US
Practice Address - Phone:407-960-5633
Practice Address - Fax:407-960-5635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68974102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F99723Medicare UPIN