Provider Demographics
NPI:1982021440
Name:SOUTHERN DUTCHESS PSYCHIATRIC CONSULTATION PLLC
Entity Type:Organization
Organization Name:SOUTHERN DUTCHESS PSYCHIATRIC CONSULTATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PE-SHEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-750-8616
Mailing Address - Street 1:26 FIREMENS MEMORIAL DR
Mailing Address - Street 2:115
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3553
Mailing Address - Country:US
Mailing Address - Phone:800-750-8616
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:1285 ROUTE 9
Practice Address - Street 2:SUITE #7
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4993
Practice Address - Country:US
Practice Address - Phone:845-632-2939
Practice Address - Fax:845-632-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-23
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA208505-12084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty