Provider Demographics
NPI:1174951891
Name:PSYCHIATRIC CONSULTANTS OF CENTRAL FLORIDA, LLC
Entity type:Organization
Organization Name:PSYCHIATRIC CONSULTANTS OF CENTRAL FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJITH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:POTLURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-962-7449
Mailing Address - Street 1:3389 W VINE ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4665
Mailing Address - Country:US
Mailing Address - Phone:407-962-7449
Mailing Address - Fax:407-563-5491
Practice Address - Street 1:3389 W VINE ST
Practice Address - Street 2:SUITE 304
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4665
Practice Address - Country:US
Practice Address - Phone:407-962-7449
Practice Address - Fax:407-563-5491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 1150042084P0805X, 2084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Single Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty