Healthcare Provider Details

I. General information

NPI: 1568665602
Provider Name (Legal Business Name): FLORIDA PSYCHIATRIC CENTER P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 TURKEY LAKE RD SUIT # 102
ORLANDO FL
32819-8015
US

IV. Provider business mailing address

8800 OAK LANDINGS CT
ORLANDO FL
32836-5002
US

V. Phone/Fax

Practice location:
  • Phone: 407-579-8759
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME0074917
License Number StateFL

VIII. Authorized Official

Name: DR. RIFFAT QURESHI
Title or Position: CEO
Credential: MD
Phone: 407-579-8759