Unknown Individual – Psychiatry Physician, NPI 1477676732

Unknown Individual is a healthcare provider. based in Tallahassee, Florida. specializing in Psychiatry Physician. They hold a License No. OS10021 (FL). The NPI Number for Unknown Individual is 1477676732

Main info

Organization
Inactive
52 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1477676732
Phone
(229) 226-0741
Address
3078 SHAMROCK ST N
Deactivation Date
17 June 2021

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
8506816001
Graduation Year
1974 (52 years ago)
PAC ID
2567455280
Group Practice PAC ID
9133022577
Professional Enrollment ID
I20110705000418
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness75
Years active:0State licenses:2Digital endpointsOther names

Provider Addresses for Unknown Individual

  • 3078 SHAMROCK ST N

    TALLAHASSEE, FL 323092735

    Phone: (229) 226-0741

    Fax: (229) 227-9360

    Type: Mailing

  • 1834A JACLIF CT

    TALLAHASSEE, FL 323084400

    Phone: (850) 681-6001

    Fax: (850) 681-6003

    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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32309)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9133022577View full group profile
NameSpecialtyState
UMESH MADHAV MHATRE (M.D.)
-FL
KARIMA ANDERSON (LCSW)
-MD
DR. ROYCE PAUL GRAY (MD)
-FL
BRANDY RAE QUEIJSEN (LCSW)
-FL
MIRIAM ELENA DE JESUS (ARNP)
-FL
EMMA IME ANDEM
-FL
JOHNATHAN PHILLIPS
-FL
MRS. JUDITH ANN HUSSEY (ARNP, BC)
-FL
ELIZABETH M NORTH (LCSW)
-FL
MRS. CLAUDIA SORRELLS NICHOLS (LCSW)
-FL

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1477676732?
NPI 1477676732 belongs to Unknown Individual; compare other details if you need extra assurance.
Can Unknown Individual still bill if the NPI is inactive?
Do not rely on inactive status alone — contact the provider for confirmation.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Psychiatry Physician. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Unknown Individual?
Travel planning: use Tallahassee, Florida as the reference point for Unknown Individual, then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.