=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124899687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY PSYCHIATRIC CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2024
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | SELECT SPECIALTY HOSPITAL 5579 S ORANGE AVE
-----------------------------------------------------
City | EDGEWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 497-241-4800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7898 WANDERING WAY
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32836-6890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 689-203-3810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. SHAHID ELAHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 689-203-3810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------