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General NPI Number Information
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NPI Number | 1548019789
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Entity Type | Organization
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Legal Business Name | SEA BREEZE PSYCHIATRY LLC
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Dates
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Enumeration Date | 05/17/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 26 ORIGINS MAIN ST STE 219
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City | INLET BEACH
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State | FL
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Zip | 32461-8647
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Country | US
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Telephone | 850-407-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 26 ORIGINS MAIN ST STE 219
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City | INLET BEACH
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State | FL
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Zip | 32461-8647
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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 | OWER/PSYCHIATRIST
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Name | DR. LAWRENCE JOHN DE LAY
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Credential | MD
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Telephone | 850-912-9875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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