MEDICARE: ULTIMATE BRAIN HEALTH LLC

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	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1427906536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTIMATE BRAIN HEALTH LLC

Provider Business Mailing Address
First Line	:	2 S BISCAYNE BLVD STE 10332ND
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-1806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 S BISCAYNE BLVD STE 10332ND
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33131-1806
Country	:	US
Telephone Number	:	786-745-8152
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MINDY DICROSTA
Credential	:
Telephone Number	:	786-745-8152

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/19/2026

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