Basic Information
| Provider Information | |||||||||
| NPI: | 1063523157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARMA BEHAVIORAL HEALTH CLINIC, LLC | ||||||||
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| OtherOrganizationName: | SARMA BEHAVIORAL HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24646 NOVA LN | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339802743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178998008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 24646 NOVA LN | ||||||||
| Address2: | |||||||||
| City: | PUNTA GORDA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339802743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178998008 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 04/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | SARMA | ||||||||
| AuthorizedOfficialFirstName: | SURESH | ||||||||
| AuthorizedOfficialMiddleName: | R. | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2178998008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.