MEDICARE: GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	310400000X	Assisted Living Facility	A11138	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5000	OTHER	FL	MENTAL HEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578711719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC

Provider Business Mailing Address
First Line	:	510 NW 98TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33150-1617
Country	:	US
Telephone Number	:	954-822-2754
Fax Number	:	954-822-2754

Provider Business Practice Location Address
First Line	:	9050 PINES BLVD STE 425-428
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-6455
Country	:	US
Telephone Number	:	954-822-2754
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	AMIR SHAHZAD
Credential	:
Telephone Number	:	916-974-9542

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	08/24/2023

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Directions to “GOOD SHEPHERD PSYCHIATRIC CONSULTANT, INC ” Practice Location

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