| Mid-florida Psychiatry Center Pl | |
|
2504 Sand Mine Rd Davenport FL 33897-3402 | |
| (863) 419-7645 | |
| Not Available |
| Full Name | Mid-florida Psychiatry Center Pl |
|---|---|
| Speciality | Clinic/Center |
| Location | 2504 Sand Mine Rd, Davenport, Florida |
| Authorized Official Name and Position | Vidyasagar Reddy Vangala (MANAGER MEMBER) |
| Authorized Official Contact | 8634197645 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-florida Psychiatry Center Pl 2504 Sand Mine Rd Davenport FL 33897-3402 Ph: (863) 419-7645 | Mid-florida Psychiatry Center Pl 2504 Sand Mine Rd Davenport FL 33897-3402 Ph: (863) 419-7645 |
| NPI Number | 1376599472 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 11/22/2010 |
| Medicare PECOS PAC ID | 4587808688 |
|---|---|
| Medicare Enrollment ID | O20130911000265 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376599472 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | ME82811 (Florida) | Primary |
| Provider Name | Vidyasaga R Vangala |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679568133 PECOS PAC ID: 4284685645 Enrollment ID: I20050203000255 |
| Provider Name | Ericka Stephens |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598084428 PECOS PAC ID: 0749529311 Enrollment ID: I20190226000445 |
| Provider Name | Lisandra Castillo Llanes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467138420 PECOS PAC ID: 3678937174 Enrollment ID: I20230918001369 |
| Provider Name | Anabel Ruiz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881373017 PECOS PAC ID: 6305291972 Enrollment ID: I20231017002539 |
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