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5545 N Wickham Rd Suite 110 Melbourne FL 32940-7323 | |
| (321) 779-9838 | |
| (321) 779-4502 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5545 N Wickham Rd, Melbourne, Florida |
| Authorized Official Name and Position | Vijaykumar R Bhujang (CEO) |
| Authorized Official Contact | 3217799838 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
5545 N Wickham Rd Suite 110 Melbourne FL 32940-7323 Ph: (321) 779-9838 | 5545 N Wickham Rd Suite 110 Melbourne FL 32940-7323 Ph: (321) 779-9838 |
| NPI Number | 1629034996 |
|---|---|
| Provider Enumeration Date | 04/25/2006 |
| Last Update Date | 04/17/2014 |
| Medicare PECOS PAC ID | 0042403610 |
|---|---|
| Medicare Enrollment ID | O20101015000513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629034996 | NPI | - | NPPES |
| 253817200 | Medicaid | FL |
| Provider Name | Abdol Amir Mirsajadi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1235196080 PECOS PAC ID: 7315040136 Enrollment ID: I20070316000073 |
| Provider Name | Rehan Farooqui |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1639393259 PECOS PAC ID: 2264527621 Enrollment ID: I20070928000704 |
| Provider Name | Barbara A Eaton |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1568607893 PECOS PAC ID: 7810022944 Enrollment ID: I20100315000883 |
| Provider Name | Jean M Masciale-shoemaker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1710943717 PECOS PAC ID: 1254599129 Enrollment ID: I20120223000207 |
| Provider Name | Sharon M Gearin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1801236427 PECOS PAC ID: 2567699747 Enrollment ID: I20131213000860 |
| Provider Name | Ryan C Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942700182 PECOS PAC ID: 4880959352 Enrollment ID: I20180604002278 |
| Provider Name | Caroline M Griffin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548686439 PECOS PAC ID: 6103047303 Enrollment ID: I20191211002822 |
| Provider Name | Anna Varela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275206716 PECOS PAC ID: 7618366790 Enrollment ID: I20211110002651 |
| Provider Name | Candace Cowan |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1952407058 PECOS PAC ID: 9133572308 Enrollment ID: I20240124003483 |
| Provider Name | James Eaton |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063479871 PECOS PAC ID: 2961855465 Enrollment ID: I20240131004450 |
| Provider Name | Justin Cusumano |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1104308675 PECOS PAC ID: 9830624451 Enrollment ID: I20241119004489 |
| Provider Name | Zahra Mctammany |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255752028 PECOS PAC ID: 2264967322 Enrollment ID: I20241126001851 |
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