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General NPI Number Information
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NPI Number | 1992696074
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Entity Type | Organization
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Legal Business Name | MOSAIC PSYCHIATRY LLC
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 3500 W INTERNATIONAL SPEEDWAY BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-1026
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Country | US
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Telephone | 407-906-3755
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Fax | 386-271-2861
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Provider Business Mailing Address
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Address Line | 3500 W INTERNATIONAL SPEEDWAY BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-1026
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Country | US
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Telephone | 407-906-3755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TAREK ALY
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Credential | MD, MPH
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Telephone | 386-314-6026
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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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