MEDICARE: BRAIN, BEAUTY, BOTOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1053144766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRAIN, BEAUTY, BOTOX

Provider Business Mailing Address
First Line	:	290 N OLIVE AVE APT 627
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-5574
Country	:	US
Telephone Number	:	561-800-8405
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 US 1 STE 340
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-3834
Country	:	US
Telephone Number	:	561-800-8405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAHIANA RAFAILOVITC
Credential	:	PMHNP
Telephone Number	:	561-800-8405

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “BRAIN, BEAUTY, BOTOX ” Practice Location

Language	Start Address	Practice Location

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