| Brandon Psychiatric Group Llc | |
|
106 W Windhorst Rd Brandon FL 33510-2455 | |
| (678) 923-6025 | |
| Not Available |
| Full Name | Brandon Psychiatric Group Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 106 W Windhorst Rd, Brandon, Florida |
| Authorized Official Name and Position | Hany Botros Mikhail (PRESIDENT) |
| Authorized Official Contact | 6789236025 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brandon Psychiatric Group Llc Po Box 1584 Cumming GA 30028-1584 Ph: (678) 923-6025 | Brandon Psychiatric Group Llc 106 W Windhorst Rd Brandon FL 33510-2455 Ph: (678) 923-6025 |
| NPI Number | 1952710147 |
|---|---|
| Provider Enumeration Date | 08/13/2014 |
| Last Update Date | 02/06/2019 |
| Medicare PECOS PAC ID | 5092095240 |
|---|---|
| Medicare Enrollment ID | O20161206001729 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952710147 | NPI | - | NPPES |
| 275940302 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | 95351 (Florida) | Primary |
| Provider Name | Hany B Mikhail |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013014737 PECOS PAC ID: 7315046588 Enrollment ID: I20070628000559 |
| Provider Name | Meshandra Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366923393 PECOS PAC ID: 0244579787 Enrollment ID: I20190228001103 |
| Provider Name | May E Hunter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114389939 PECOS PAC ID: 4486993821 Enrollment ID: I20190304000479 |
| Provider Name | Sierra Shankle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891339776 PECOS PAC ID: 1557757036 Enrollment ID: I20220409000221 |
| Provider Name | Dipa Digantbhai Solanki |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851947600 PECOS PAC ID: 4789063298 Enrollment ID: I20220613003174 |
| Provider Name | Andrea Lynn Fisher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831781392 PECOS PAC ID: 3678952330 Enrollment ID: I20220627001450 |
| Provider Name | Gary James Farinas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093854929 PECOS PAC ID: 3971977836 Enrollment ID: I20230316002010 |
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