Healthcare Provider Details

I. General information

NPI: 1790283695
Provider Name (Legal Business Name): T.P.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 ALOMA AVE
WINTER PARK FL
32792-3752
US

IV. Provider business mailing address

7228 CLARCONA OCOEE RD UNIT 124
CLARCONA FL
32710-2001
US

V. Phone/Fax

Practice location:
  • Phone: 407-567-7011
  • Fax: 407-567-7011
Mailing address:
  • Phone: 321-437-3715
  • Fax: 407-567-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: LATONYA SMITH
Title or Position: MEDICAL PROVIDER
Credential: MS
Phone: 321-437-3715