MEDICARE: PSYCHIATRY & PSYCHOTHERAPY PLLC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1770222432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRY & PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	222 W COMSTOCK AVE STE 202
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4272
Country	:	US
Telephone Number	:	909-720-2749
Fax Number	:	909-255-9752

Provider Business Practice Location Address
First Line	:	222 W COMSTOCK AVE STE 202
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32789-4272
Country	:	US
Telephone Number	:	909-720-2749
Fax Number	:	909-255-9752

Authorized Official
Title or Position	:	CEO, MEDICAL DIRECTOR
Name	:	DR. DAVID JOHANN PUDER
Credential	:	MD
Telephone Number	:	909-720-2749

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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