=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447275243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PALM BEACH PSYCHIATRIC AND ADDICTION CENTER, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1115 45TH ST SUITE 1
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407-2376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-863-4600
-----------------------------------------------------
Fax | 561-863-4646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1115 45TH STREET SUITE 1
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-863-4600
-----------------------------------------------------
Fax | 561-863-4646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DIRECTOR
-----------------------------------------------------
Name | WOMESH C SAHADEO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-863-4600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | ME0050472
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------