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General NPI Number Information
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NPI Number | 1376122515
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Entity Type | Organization
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Legal Business Name | THRIVING LANE
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Dates
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Enumeration Date | 04/05/2021
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Last Update Date | 11/22/2023
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Provider Practice Location Address
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Address Line | 4933 TAMIAMI TRL N STE 200
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City | NAPLES
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State | FL
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Zip | 34103-3028
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Country | US
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Telephone | 347-830-7720
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Fax | 561-948-2803
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Provider Business Mailing Address
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Address Line | 200 2ND AVE S STE 356
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City | SAINT PETERSBURG
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State | FL
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Zip | 33701-4313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAMA RATHI
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Credential | MD
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Telephone | 347-830-7720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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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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