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Organization

PBH PROFESSIONAL GROUP, P.A.

Active
Other names
PATH 5Palms Professional Group
Organization subpart
No

Provider details

NPI number
Authorized official
FLORA SADRI-AZARBAYEJANI D.O. (PRESIDENT AND SECRETARY)
(413) 522-9246
Entity
Organization

Contact information

Practice address
1200 W GRANADA BLVD STE 1A, ORMOND BEACH, FL 32174-8157
(386) 506-8110
(386) 463-2170
Mailing address
103 POWELL CT STE 100, BRENTWOOD, TN 37027-5050
(615) 308-7871

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
163W00000X
Registered Nurse
207Q00000X
Family Medicine Physician
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
Primary
2084P0800X
Psychiatry Physician
363LP0808X
Psychiatric/Mental Health Nurse Practitioner

Other

Enumeration date
07/28/2021
Last updated
07/28/2021
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