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General NPI Number Information
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NPI Number | 1174913958
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Entity Type | Organization
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Legal Business Name | LEE COUNTY ASSOCIATES IN PSYCHIATRY
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Dates
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Enumeration Date | 01/30/2015
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Last Update Date | 01/30/2015
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Provider Practice Location Address
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Address Line | 1303 HOMESTEAD RD N STE 103
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-6049
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Country | US
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Telephone | 917-639-6261
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 HOMESTEAD RD N STE 103
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City | LEHIGH ACRES
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State | FL
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Zip | 33936-6049
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Country | US
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Telephone | 917-639-6261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRANDON A SHORT
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Credential | PA-C
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Telephone | 917-639-6261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | PA 9105830
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License Number State | FL
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