Healthcare Provider Details

I. General information

NPI: 1003680026
Provider Name (Legal Business Name): SNA PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2023
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 NW 57TH ST UNIT 25537
TAMARAC FL
33320-8424
US

IV. Provider business mailing address

7875 NW 57TH ST UNIT 25537
TAMARAC FL
33320-8424
US

V. Phone/Fax

Practice location:
  • Phone: 754-229-9434
  • Fax:
Mailing address:
  • Phone:
  • 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: AMA ADUSEI
Title or Position: CEO
Credential: PA
Phone: 347-463-2773