Provider Demographics
NPI:1215304613
Name:SYNERGISTIQ INTEGRATIVE HEALTH P A
Entity type:Organization
Organization Name:SYNERGISTIQ INTEGRATIVE HEALTH P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-754-7936
Mailing Address - Street 1:3165 N MCMULLEN BOOTH RD STE D-2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2020
Mailing Address - Country:US
Mailing Address - Phone:727-754-2936
Mailing Address - Fax:
Practice Address - Street 1:3165 N MCMULLEN BOOTH RD
Practice Address - Street 2:SUITE D-2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2032
Practice Address - Country:US
Practice Address - Phone:727-754-2936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95465261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care