Healthcare Provider Details

I. General information

NPI: 1053034462
Provider Name (Legal Business Name): SEAGLASS PSYCHIATRY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 JUPITER LAKES BLVD STE 302B
JUPITER FL
33458-7100
US

IV. Provider business mailing address

345 JUPITER LAKES BLVD STE 302B
JUPITER FL
33458-7100
US

V. Phone/Fax

Practice location:
  • Phone: 772-202-6878
  • Fax: 334-232-2473
Mailing address:
  • Phone: 772-202-6878
  • Fax: 334-232-2473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE GUINAN
Title or Position: OWNER/SOLE MEMBER
Credential: MD
Phone: 772-202-6878