Unknown Individual – Psychiatry Physician, NPI 1407055171

Unknown Individual is a healthcare provider. based in Largo, Florida. specializing in Psychiatry Physician. They hold a License No. ME106165 (FL). The NPI Number for Unknown Individual is 1407055171

Main info

Organization
Inactive
23 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1407055171
Phone
(727) 415-4462
Address
10647 PARK PLACE DR
Deactivation Date
31 January 2024

Doctor Profile

Medical School Name
MEHARRY MEDICAL COLLEGE SCHOOL OF MEDICINE
Secondary Phone
7274154462
Graduation Year
2003 (23 years ago)
PAC ID
9830131283
Professional Enrollment ID
I20100804000577

Contacts

Other Endpoint
Mailing
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 10647 PARK PLACE DR

    SUITE 3N

    LARGO, FL 337783409

    Phone: (727) 415-4462

    Fax: (727) 362-9210

    Type: Mailing

  • 5730 Lake Underhill Rd

    Orlando, FL 328074366

    Phone: (407) 322-8645

    Fax: (407) 269-8986

    Type: Location

  • 11215 Metro Pkwy Ste 1

    Fort Myers, FL 339661206

    Phone: (239) 208-2212

    Type: Location

  • 9355, 113th Street North, Seminole, Pinellas County, Florida, 33772, United States

    UNIT 3500

    SEMINOLE, FL 337756820

    Phone: (727) 415-4462

    Fax: (727) 362-9210

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99213Established patient office or other outpatient visit, 20-29 minutes7517$0
90837Psychotherapy, 1 hour4015$0
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Insurance plans in this area (ZIP 33778)

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Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?
Public records show Unknown Individual under NPI 1407055171.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Psychiatry Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
What geographic area is tied to Unknown Individual?
Unknown Individual is associated with Largo, Florida in the same public data insurers reference.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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