Provider Demographics
NPI:1053156836
Name:PROMOVEO PSYCHIATRY AND WELLNESS P.A.
Entity type:Organization
Organization Name:PROMOVEO PSYCHIATRY AND WELLNESS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIBIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUSAIMANICKAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-299-0202
Mailing Address - Street 1:2091 NE 36TH ST # 5472
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7538
Mailing Address - Country:US
Mailing Address - Phone:561-299-0202
Mailing Address - Fax:561-299-0505
Practice Address - Street 1:2691 NE 20TH ST
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3022
Practice Address - Country:US
Practice Address - Phone:561-299-0202
Practice Address - Fax:561-299-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty