Healthcare Provider Details

I. General information

NPI: 1467541144
Provider Name (Legal Business Name): SAND DOLLAR PSYCHIATRIC SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 CRYSTAL BEACH DR STE 137-C
DESTIN FL
32541-3569
US

IV. Provider business mailing address

PO BOX 1648
DESTIN FL
32540-1648
US

V. Phone/Fax

Practice location:
  • Phone: 850-226-7100
  • Fax:
Mailing address:
  • Phone: 850-226-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA L SHELTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 850-226-7100