Provider Demographics
NPI:1548098742
Name:PRESTIGE PSYCHIATRY
Entity type:Organization
Organization Name:PRESTIGE PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAFAE
Authorized Official - Middle Name:SYED
Authorized Official - Last Name:AGHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-805-7051
Mailing Address - Street 1:4800 KELLER SPRINGS RD APT 1487
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6542
Mailing Address - Country:US
Mailing Address - Phone:817-805-7501
Mailing Address - Fax:
Practice Address - Street 1:14275 MIDWAY RD STE 200
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3618
Practice Address - Country:US
Practice Address - Phone:817-805-7051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty