# BROADWAY PSYCHIATRY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750907879
- **Authorized official:** VELILE SIBUSISIWE NKOLOMI NP (CEO)
- **Authorized official phone:** (469) 733-2090

## Contact information

- **Practice address:** 3960 BROADWAY BLVD STE 232, GARLAND, TX 75043-2591
- **Practice address phone:** (469) 733-2090
- **Mailing address:** 2657 JOHNSON CT, FORNEY, TX 75126-1696
- **Mailing address phone:** (469) 733-2090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 06/24/2020
- **Last updated:** 07/11/2020