Psych-MD, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

PSYCH-MD, LLC

Practice address

11924 NW 12TH St
Pembroke Pines, FL 33026-3856

Phone

(954) 997-1967

NPI assigned

Apr 20, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Oluleye Adigun, MCAP

Title

Ceo

Phone

(954) 997-1967

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1255994604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11924 NW 12TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263856",
            "telephone_number": "954-997-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11924 NW 12TH ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330263856",
            "telephone_number": "954-997-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PSYCH-MD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-20",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "ADIGUN",
        "authorized_official_first_name": "OLULEYE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "954-997-1967",
        "authorized_official_credential": "MCAP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.