MEDICARE: SSQ PSYCHIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TF0200X	Forensic Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1730603515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SSQ PSYCHIATRY LLC

Provider Business Mailing Address
First Line	:	540 BRICKELL KEY DR APT 1426
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3534
Country	:	US
Telephone Number	:	228-282-0697
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 BRICKELL KEY DR APT 1426
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-3534
Country	:	US
Telephone Number	:	228-282-0697
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SANA QURESHI
Credential	:
Telephone Number	:	228-282-0697

Provider Enumeration Date	:	08/02/2017
Last Update Date	:	07/21/2022

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