Provider Demographics
NPI:1457621641
Name:PSYCHIATRY ASSOCIATES OF TEXAS, P.A.
Entity Type:Organization
Organization Name:PSYCHIATRY ASSOCIATES OF TEXAS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIL
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:TUKDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-596-4393
Mailing Address - Street 1:5501 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023
Mailing Address - Country:US
Mailing Address - Phone:972-596-4393
Mailing Address - Fax:972-596-4840
Practice Address - Street 1:5501 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023
Practice Address - Country:US
Practice Address - Phone:972-596-4393
Practice Address - Fax:972-596-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-05
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL89862084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB156896Medicare PIN