Healthcare Provider Details

I. General information

NPI: 1164788584
Provider Name (Legal Business Name): A SHARED VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CORAL WAY SUITE 401
MIAMI FL
33145-3053
US

IV. Provider business mailing address

3400 CORAL WAY SUITE 401
MIAMI FL
33145-3053
US

V. Phone/Fax

Practice location:
  • Phone: 305-567-1155
  • Fax: 305-448-6915
Mailing address:
  • Phone: 305-567-1155
  • Fax: 305-448-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberMH3510
License Number StateFL

VIII. Authorized Official

Name: MS. ANA M PANDO
Title or Position: DIRECTOR
Credential: PHD
Phone: 305-567-1155