Healthcare Provider Details

I. General information

NPI: 1467363655
Provider Name (Legal Business Name): DPSYCHDOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 N FEDERAL HWY APT 406
FORT LAUDERDALE FL
33304-1402
US

IV. Provider business mailing address

1170 N FEDERAL HWY APT 406
FORT LAUDERDALE FL
33304-1402
US

V. Phone/Fax

Practice location:
  • Phone: 954-219-3929
  • Fax: 954-838-5381
Mailing address:
  • Phone: 954-219-3929
  • Fax: 954-838-5381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMALA RUSSELL
Title or Position: OWNER
Credential:
Phone: 754-244-4393