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  7. NPI Record 1497409767

SUNTREE PSYCHIATRY
Complete NPI Record 1497409767
Nurse Practitioner - Psychiatric/Mental Health in Melbourne, FL

NPI Status: Active since February 07, 2022

Contact Information

3040 N WICKHAM RD STE 3
MELBOURNE, FL
ZIP 32935
Phone: (321) 456-9653
Fax: (321) 204-9168

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Business Mailing Address City Name
  9. Provider Business Mailing Address State Name
  10. Provider Business Mailing Address Postal Code
  11. Provider Business Mailing Address Country Code If outside U S
  12. Provider Business Mailing Address Telephone Number
  13. Provider Business Mailing Address Fax Number
  14. Provider First Line Business Practice Location Address
  15. Provider Business Practice Location Address City Name
  16. Provider Business Practice Location Address State Name
  17. Provider Business Practice Location Address Postal Code
  18. Provider Business Practice Location Address Country Code If outside U S
  19. Provider Business Practice Location Address Telephone Number
  20. Provider Business Practice Location Address Fax Number
  21. Provider Enumeration Date
  22. Last Update Date
  23. Authorized Official Last Name
  24. Authorized Official First Name
  25. Authorized Official Middle Name
  26. Authorized Official Title or Position
  27. Authorized Official Telephone Number
  28. Healthcare Provider Taxonomy Code 1
  29. Healthcare Provider Primary Taxonomy Switch 1
  30. Is Organization Subpart
  31. Authorized Official Name Prefix Text
  32. Authorized Official Name Suffix Text
  33. Authorized Official Credential Text
  34. Healthcare Provider Taxonomy Group 1
  35. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1497409767. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1497409767
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 2
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EIN: UNAVAIL
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization Name: SUNTREE PSYCHIATRY
Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code: 3
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address: 3040 N WICKHAM RD STE 3
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City Name: MELBOURNE
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address State Name: FL
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Postal Code: 329352369
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Telephone Number: 3214569653
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3212049168
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider First Line Business Practice Location Address: 3040 N WICKHAM RD STE 3
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MELBOURNE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: FL
The city name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code: 329352369
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number: 3214569653
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3212049168
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 2/7/2022
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 8/21/2023
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Last Name: CARROLL
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: HARRY
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official Middle Name: W
The middle name of the authorized official.
Authorized Official Title or Position: MGR
The middle name of the authorized official.
Authorized Official Telephone Number: 9542054551
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 363LP0808X
The 10-position telephone number of the authorized official.
Healthcare Provider Primary Taxonomy Switch 1: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.
Authorized Official Name Suffix Text: IV
Authorized Official Credential Text: APRN, FNP-C, PMHNP
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP
NPI Certification Date: 8/21/2023