Provider Demographics
NPI:1487972980
Name:MAHARAJ, SAVIANNE VINTON (PSYD)
Entity type:Individual
Prefix:
First Name:SAVIANNE
Middle Name:VINTON
Last Name:MAHARAJ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 SAWGRASS CORP PARKWAY #450
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323
Mailing Address - Country:US
Mailing Address - Phone:561-262-6048
Mailing Address - Fax:561-828-9209
Practice Address - Street 1:1560 SAWGRASS CORP PARKWAY #450
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:561-262-6048
Practice Address - Fax:561-828-9209
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8634103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008545700Medicaid