Healthcare Provider Details

I. General information

NPI: 1871118380
Provider Name (Legal Business Name): ALTERNATIVE PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8788 SR 70 E SUITE 101
BRADENTON FL
34202
US

IV. Provider business mailing address

8788 SR 70 E SUITE 101
BRADENTON FL
34202
US

V. Phone/Fax

Practice location:
  • Phone: 941-444-8028
  • Fax: 941-296-7296
Mailing address:
  • Phone: 941-444-8028
  • Fax: 941-296-7296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK EINAR SYLVESTER
Title or Position: PRESIDENT
Credential: MD
Phone: 941-444-8028