MEDICARE: SARMA BEHAVIORAL HEALTH CLINIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1063523157
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARMA BEHAVIORAL HEALTH CLINIC, LLC

Provider Business Mailing Address
First Line	:	24646 NOVA LN
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33980-2743
Country	:	US
Telephone Number	:	217-899-8008
Fax Number	:

Provider Business Practice Location Address
First Line	:	24646 NOVA LN
Second Line	:
City	:	PUNTA GORDA
State	:	FL
Zip	:	33980-2743
Country	:	US
Telephone Number	:	217-899-8008
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SURESH R. SARMA
Credential	:	M.D.
Telephone Number	:	217-899-8008

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	04/16/2018

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