Basic Information
Provider Information | |||||||||
NPI: | 1164812269 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KEY BISCAYNE PSYCHIATRY | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 240 CRANDON BLVD STE 230 | ||||||||
Address2: |   | ||||||||
City: | KEY BISCAYNE | ||||||||
State: | FL | ||||||||
PostalCode: | 331491624 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3054390085 | ||||||||
FaxNumber: | 3054396054 | ||||||||
Practice Location | |||||||||
Address1: | 240 CRANDON BLVD STE 230 | ||||||||
Address2: |   | ||||||||
City: | KEY BISCAYNE | ||||||||
State: | FL | ||||||||
PostalCode: | 331491624 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3054390085 | ||||||||
FaxNumber: | 3054396054 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/27/2015 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | JOYA | ||||||||
AuthorizedOfficialFirstName: | LIZ | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3804390085 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X |   |   | N |   | Hospitals | Psychiatric Hospital |   | 2084N0400X | ME102618 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.