Provider Demographics
NPI:1578387817
Name:EPIPHANY INTEGRATED HEALTH
Entity type:Organization
Organization Name:EPIPHANY INTEGRATED HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:III
Authorized Official - Credentials:MS, APRN, PMHNP-BC
Authorized Official - Phone:941-367-2356
Mailing Address - Street 1:1990 MAIN ST STE 750
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8000
Mailing Address - Country:US
Mailing Address - Phone:941-367-2356
Mailing Address - Fax:
Practice Address - Street 1:1990 MAIN ST STE 750
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8000
Practice Address - Country:US
Practice Address - Phone:941-367-2356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-13
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty