Provider Demographics
NPI:1548019789
Name:SEA BREEZE PSYCHIATRY LLC
Entity type:Organization
Organization Name:SEA BREEZE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWER/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DE LAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-912-9875
Mailing Address - Street 1:26 ORIGINS MAIN ST STE 219
Mailing Address - Street 2:
Mailing Address - City:INLET BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32461-8647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:26 ORIGINS MAIN ST STE 219
Practice Address - Street 2:
Practice Address - City:INLET BEACH
Practice Address - State:FL
Practice Address - Zip Code:32461-8647
Practice Address - Country:US
Practice Address - Phone:850-407-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-17
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty