Provider Demographics
NPI:1215781539
Name:ENHANCED PSYCHIATRY LLC
Entity type:Organization
Organization Name:ENHANCED PSYCHIATRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAXI
Authorized Official - Middle Name:INEZ
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP, BC
Authorized Official - Phone:321-872-8443
Mailing Address - Street 1:2903 W NEW HAVEN AVE # 591
Mailing Address - Street 2:
Mailing Address - City:W MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3661
Mailing Address - Country:US
Mailing Address - Phone:321-872-8443
Mailing Address - Fax:
Practice Address - Street 1:586 ADDISON AVE NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2499
Practice Address - Country:US
Practice Address - Phone:321-872-8443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty