Provider Demographics
NPI:1568043537
Name:ANIMO SANO PSYCHIATRY PLLC
Entity type:Organization
Organization Name:ANIMO SANO PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-391-7202
Mailing Address - Street 1:5501 FORTUNES RIDGE DR STE P
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6102
Mailing Address - Country:US
Mailing Address - Phone:919-391-7202
Mailing Address - Fax:919-391-7203
Practice Address - Street 1:5501 FORTUNES RIDGE DR STE P
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6102
Practice Address - Country:US
Practice Address - Phone:919-391-7202
Practice Address - Fax:919-391-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health