1528172731 NPI number — ORLANDO PSYCHIATRIC ASSOCIATES INC.

Table of content: (NPI 1528172731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528172731 NPI number — ORLANDO PSYCHIATRIC ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORLANDO PSYCHIATRIC ASSOCIATES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OPA BEHAVIORAL HEALTH INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528172731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 714
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINDERMERE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34786-0714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-851-5121
Provider Business Mailing Address Fax Number:
407-851-0439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2345 SAND LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32809-9142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-851-5121
Provider Business Practice Location Address Fax Number:
407-851-0439
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAJU
Authorized Official First Name:
BHASKAR
Authorized Official Middle Name:
NANDIMANDALAM
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-851-5121

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X , with the licence number:  ME91130 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009616900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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