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General NPI Number Information
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NPI Number | 1104605484
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Entity Type | Organization
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Legal Business Name | SERENITY BEHAVIORAL MEDICINE LLC
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Dates
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Enumeration Date | 09/26/2023
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Last Update Date | 09/26/2023
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Provider Practice Location Address
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Address Line | 1015 US HIGHWAY 19
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City | HOLIDAY
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State | FL
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Zip | 34691-5636
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Country | US
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Telephone | 727-935-1144
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Fax | 727-935-1133
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Provider Business Mailing Address
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Address Line | 1015 US HIGHWAY 19
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City | HOLIDAY
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State | FL
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Zip | 34691-5636
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Country | US
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Telephone | 727-935-1144
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Fax | 727-935-1133
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Authorized Official
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Title or Position | OWNER
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Name | MONA SHAH
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Credential | DO
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Telephone | 727-421-5145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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