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General NPI Number Information
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NPI Number | 1164788584
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Entity Type | Organization
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Legal Business Name | A SHARED VISION
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 3400 CORAL WAY SUITE 401
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City | MIAMI
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State | FL
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Zip | 33145-3053
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Country | US
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Telephone | 305-567-1155
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Fax | 305-448-6915
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Provider Business Mailing Address
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Address Line | 3400 CORAL WAY SUITE 401
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City | MIAMI
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State | FL
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Zip | 33145-3053
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Country | US
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Telephone | 305-567-1155
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Fax | 305-448-6915
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ANA M PANDO
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Credential | PHD
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Telephone | 305-567-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | MH3510
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License Number State | FL
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