Organization
ADLY THEBAUD,MD,PA
Active
Other names
Family Psychiatry Services
Organization subpart
No
Provider details
NPI number
Authorized official
ADLY THEBAUD (OWNER/PROVIDER)
(386) 775-0736
Entity
Organization
Contact information
Practice address
2725 REBECCA LN STE 107, ORANGE CITY, FL 32763-8350
(386) 775-0736
(386) 775-0738
Mailing address
2725 REBECCA LN STE 107, ORANGE CITY, FL 32763-8350
(386) 775-0736
(386) 775-0738
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
ME60436
FL
251S00000X
Community/Behavioral Health Agency
Primary
—
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
ARNP 9231203
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
ARNP 9410846
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010364600
—
FL
01
—
K0231
MEDICARE
FL
01
—
W9584
MEDICARE
FL
Enumeration date
12/13/2006
Last updated
04/06/2026
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