ADLY THEBAUD,MD,PA
Nursing at Medical Plaza Dr, Sanford, FL

License number
Florida MH7091
Category
Mental Health
Type
Mental Health
License number
Florida SW13051
Category
Social Work
Type
Clinical
License number
Florida ME60436
Category
Psychiatric
Type
Child & Adolescent Psychiatry
License number
Florida ARNP 9410846
Category
Nursing
Type
Psychiatric/Mental Health
License number
Florida ARNP 9231203
Category
Nursing
Type
Psychiatric/Mental Health
Owner
Name: DR. ADLY THEBAUD MD
Title: OWNER
Phone: (407) 322-3096
Address
Address
1403 Medical Plaza Dr SUITE 202, Sanford, FL 32771
National Provider ID: 1417018482
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about ADLY THEBAUD,MD,PA at bizstanding.com

ADLY THEBAUD, M.D., PA

1403 Medical Plz Dr SUITE 202, Sanford, FL 32771

Status:
Inactive
Inactive reason:
Reinstatement
Registration:
Oct 22, 1991
Inactive since:
May 2, 1996
State ID:
S88940
Business type:
Florida Profit Corporation
Directors:
Thebaud, Adly, M.d, 1403 Medical Plz Dr, Sanford, FL 32771 (Physical),Adly Thebaud (Director)
Agent:
Thebaud, Adly,1403 Medical Plz Dr SUITE 202, Sanford, FL 32771 (Physical)
EIN:
593088555

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