Provider Demographics
NPI:1669101861
Name:BREVARD PSYCHIATRY LLC
Entity type:Organization
Organization Name:BREVARD PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/100 PERCENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:HON-FU
Authorized Official - Last Name:SIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-287-6833
Mailing Address - Street 1:6300 N WICKHAM RD
Mailing Address - Street 2:STE 130 #156
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2029
Mailing Address - Country:US
Mailing Address - Phone:801-609-8388
Mailing Address - Fax:801-797-0245
Practice Address - Street 1:101 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901
Practice Address - Country:US
Practice Address - Phone:801-609-8388
Practice Address - Fax:801-797-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty