Healthcare Provider Details

I. General information

NPI: 1043460421
Provider Name (Legal Business Name): SERENITY OF CENTRAL FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9425 SE HIGHWAY 42
SUMMERFIELD FL
34491-6405
US

IV. Provider business mailing address

9425 SE HIGHWAY 42
SUMMERFIELD FL
34491-6405
US

V. Phone/Fax

Practice location:
  • Phone: 352-347-6272
  • Fax:
Mailing address:
  • Phone: 352-347-6272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2084P0800X
License Number StateFL

VIII. Authorized Official

Name: DR. YASIN MOHSIN CHOUDRY
Title or Position: PHSYCHIATRIST
Credential: M.D.
Phone: 352-347-6272