Organization
EVOLUTION PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNAN VICTORINO (OWNER)
(774) 365-9192
Entity
Organization
Contact information
Practice address
915 MIDDLE RIVER DR STE 103C, FORT LAUDERDALE, FL 33304-3559
(774) 365-9192
Mailing address
3012 SAN CLARA DR # 18C, DELRAY BEACH, FL 33445-5429
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
01/19/2022
Last updated
01/19/2022
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