| Family Psychiatry Services | |
|
2725 Rebecca Ln Ste 107 Orange City FL 32763-8350 | |
| (386) 775-0736 | |
| (386) 775-0738 |
| Full Name | Family Psychiatry Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2725 Rebecca Ln Ste 107, Orange City, Florida |
| Authorized Official Name and Position | Adly Thebaud (OWNER) |
| Authorized Official Contact | 3867750736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Psychiatry Services 2725 Rebecca Ln Ste 107 Orange City FL 32763-8350 Ph: (386) 775-0736 | Family Psychiatry Services 2725 Rebecca Ln Ste 107 Orange City FL 32763-8350 Ph: (386) 775-0736 |
| NPI Number | 1417018482 |
|---|---|
| Provider Enumeration Date | 12/13/2006 |
| Last Update Date | 11/09/2023 |
| Certification Date | 11/09/2023 |
| Medicare PECOS PAC ID | 0143270579 |
|---|---|
| Medicare Enrollment ID | O20050124001039 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417018482 | NPI | - | NPPES |
| K0231 | Other | FL | MEDICARE |
| 010364600 | Medicaid | FL |
| Provider Name | N Kelly Speranzo Otero |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679797856 PECOS PAC ID: 1052331881 Enrollment ID: I20051123000054 |
| Provider Name | Adly Thebaud |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629049770 PECOS PAC ID: 5597715920 Enrollment ID: I20110406000825 |
| Provider Name | Josette Romain |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851408348 PECOS PAC ID: 0042488173 Enrollment ID: I20110715000516 |
| Provider Name | Fhteachia Michelle Andrews |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366854598 PECOS PAC ID: 4789803750 Enrollment ID: I20180605001214 |
| Provider Name | Cheryl Adkinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013658137 PECOS PAC ID: 0547649980 Enrollment ID: I20220615002128 |
| Provider Name | Jessica K Shutt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700052214 PECOS PAC ID: 7315016201 Enrollment ID: I20231113001538 |
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