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NPI Code Detail

MEDICARE: MIND REFINED

MEDICARE: MIND REFINED
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
1261QX0200XOncology Clinic/Center
2363LF0000XFamily Nurse Practitioner
3363LP0808XPsychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number : 1396590659
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIND REFINED
Provider Business Mailing Address
First Line : 14649 SW 42ND ST, PMB 134
Second Line :
City : MIAMI
State : FL
Zip : 33175-7825
Country : US
Telephone Number : 305-290-2175
Fax Number : 305-290-2176
Provider Business Practice Location Address
First Line : 3191 CORAL WAY STE 607
Second Line :
City : MIAMI
State : FL
Zip : 33145-3230
Country : US
Telephone Number : 305-290-2176
Fax Number : 305-290-2176
Authorized Official
Title or Position : CEO
Name : MICHELLE ANDREA VON DER HEYDE
Credential : NP
Telephone Number : 305-290-2175
Provider Enumeration Date : 04/20/2024
Last Update Date : 12/12/2025

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Directions to “MIND REFINED ” Practice Location

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