Healthcare Provider Details

I. General information

NPI: 1851162770
Provider Name (Legal Business Name): PSYCHIATRY & PSYCHOTHERAPY OF FLORIDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9057 ABBOTT AVE
SURFSIDE FL
33154-3235
US

IV. Provider business mailing address

9057 ABBOTT AVE
SURFSIDE FL
33154-3235
US

V. Phone/Fax

Practice location:
  • Phone: 305-202-4768
  • Fax: 954-990-7650
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ESTEBAN CARDONNE
Title or Position: OWNER
Credential:
Phone: 305-202-4768