Healthcare Provider Details

I. General information

NPI: 1073754594
Provider Name (Legal Business Name): PHYSICIANS COLLABORATIVE ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 01/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W COLONIAL DR SUITE 302
ORLANDO FL
32804-6863
US

IV. Provider business mailing address

PO BOX 547066
ORLANDO FL
32854-7066
US

V. Phone/Fax

Practice location:
  • Phone: 407-362-6003
  • Fax: 407-362-6007
Mailing address:
  • Phone: 407-362-6003
  • Fax: 407-362-6007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SANJEEV SINGH
Title or Position: OWNER
Credential: MD
Phone: 407-362-6003