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General NPI Number Information
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NPI Number | 1679856199
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Entity Type | Organization
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Legal Business Name | FLORIDA PSYCHIATRIC ASSOCIATES LLC
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 166 LOOKOUT PL SUITE 100
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City | MAITLAND
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State | FL
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Zip | 32751-4496
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Country | US
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Telephone | 407-960-5633
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Fax | 407-960-5635
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Provider Business Mailing Address
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Address Line | PO BOX 940953
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City | MAITLAND
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State | FL
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Zip | 32794-0953
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Country | US
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Telephone | 407-969-5633
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Fax | 407-960-5635
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANNE FATIMA MIAN
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Credential | M.D.
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Telephone | 407-342-3709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | ME68974
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License Number State | FL
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