Healthcare Provider Details

I. General information

NPI: 1023533635
Provider Name (Legal Business Name): PSYCH/MED PROS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W SUNRISE BLVD STE 3
FT LAUDERDALE FL
33311-6200
US

IV. Provider business mailing address

300 W SUNRISE BLVD STE 3
FT LAUDERDALE FL
33311-6200
US

V. Phone/Fax

Practice location:
  • Phone: 754-234-0155
  • Fax: 954-206-6443
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD STERNE
Title or Position: CLINICIAN
Credential: MSN, ARNP, FNP-BC
Phone: 754-234-0155