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General NPI Number Information
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NPI Number | 1730689290
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Entity Type | Organization
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Legal Business Name | SUNCOAST NEUROPSYCHIATRIC WELLNESS CENTER LLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 25097 E OLYMPIA AVE #200
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City | PUNTA GORDA
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State | FL
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Zip | 33950
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Country | US
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Telephone | 941-655-8085
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Fax | 941-347-8218
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Provider Business Mailing Address
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Address Line | 25097 E OLYMPIA AVE #200
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3914
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Country | US
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Telephone | 941-655-8085
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Fax | 941-347-8218
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Authorized Official
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Title or Position | MD
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Name | LAURA F TAIT
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Credential | MD
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Telephone | 941-655-8085
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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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