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General NPI Number Information
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NPI Number | 1902076524
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Entity Type | Organization
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Legal Business Name | MONROSE CLINIC ASSOCIATES FOR PSYCHOLOGICAL MEDICINE
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 3627 UNIVERSITY BLVD SOUTH SUITE 615
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City | JACKSONVILLE
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State | FL
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Zip | 32216-2721
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Country | US
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Telephone | 904-725-6463
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Fax | 904-724-5006
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Provider Business Mailing Address
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Address Line | 3627 UNIVERSITY BLVD S STE 615
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City | JACKSONVILLE
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State | FL
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Zip | 32216-7401
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Country | US
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Telephone | 904-725-6463
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Fax | 904-724-5006
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Authorized Official
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Title or Position | PSYCHIATRISTS
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Name | DR. ATUL M SHAH
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Credential | M.D.
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Telephone | 904-725-6463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ME0048902
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License Number State | FL
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