Healthcare Provider Details

I. General information

NPI: 1285295915
Provider Name (Legal Business Name): FLORIDA PSYCHIATRY SERVICES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ANCHOR RODE DR
NAPLES FL
34103-2739
US

IV. Provider business mailing address

818 ANCHOR RODE DR
NAPLES FL
34103-2739
US

V. Phone/Fax

Practice location:
  • Phone: 239-227-4289
  • Fax:
Mailing address:
  • Phone: 239-227-4289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM MAITE SEVILLA SAEZ-BENITO
Title or Position: PSYCHIATRY
Credential: MD
Phone: 227-239-4289