Provider Demographics
NPI:1467467266
Name:MINDPATH HEALTH FLORIDA, PLLC
Entity type:Organization
Organization Name:MINDPATH HEALTH FLORIDA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OFFICER AND DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FNU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIYANKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-490-2067
Mailing Address - Street 1:3835 N FREEWAY BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1954
Mailing Address - Country:US
Mailing Address - Phone:916-576-7901
Mailing Address - Fax:162-779-3809
Practice Address - Street 1:1725 N UNIVERSITY DR
Practice Address - Street 2:SUITE # 350
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071
Practice Address - Country:US
Practice Address - Phone:954-227-2700
Practice Address - Fax:957-227-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1643Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER