| Victory Bh | |
|
1530 Kingsley Ave Orange Park FL 32073-4511 | |
| (908) 451-1566 | |
| (716) 237-4199 |
| Full Name | Victory Bh |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1530 Kingsley Ave, Orange Park, Florida |
| Authorized Official Name and Position | Snehal Shah (OWNER) |
| Authorized Official Contact | 9084511566 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Bh 1335 Kingsley Ave Unit 458 Orange Park FL 32067-7719 Ph: (908) 451-1566 | Victory Bh 1530 Kingsley Ave Orange Park FL 32073-4511 Ph: (908) 451-1566 |
| NPI Number | 1609584358 |
|---|---|
| Provider Enumeration Date | 11/11/2022 |
| Last Update Date | 02/21/2023 |
| Certification Date | 02/21/2023 |
| Medicare PECOS PAC ID | 9830564822 |
|---|---|
| Medicare Enrollment ID | O20230405000014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609584358 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Snehal Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417123605 PECOS PAC ID: 1052509098 Enrollment ID: I20230405002015 |
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