MEDICARE: FLORIDA UNITED PSYCH PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208000000X	Pediatrics Physician
2	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	101YM0800X	Mental Health Counselor
6	103K00000X	Behavior Analyst
7	103TC0700X	Clinical Psychologist
8	207Q00000X	Family Medicine Physician
9	207R00000X	Internal Medicine Physician
10	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1205702339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA UNITED PSYCH PLLC

Provider Business Mailing Address
First Line	:	4700 N HABANA AVE STE 601
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7121
Country	:	US
Telephone Number	:	201-706-1143
Fax Number	:	832-241-2902

Provider Business Practice Location Address
First Line	:	4700 N HABANA AVE STE 601
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-7121
Country	:	US
Telephone Number	:	201-706-1143
Fax Number	:	832-241-2902

Authorized Official
Title or Position	:	CEO
Name	:	FAISAL TAI
Credential	:	MD
Telephone Number	:	201-706-1143

Provider Enumeration Date	:	10/15/2025
Last Update Date	:	10/15/2025

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