MEDICARE: BRIGHTSIDE HEALTH AND WELLNESS

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1568146967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHTSIDE HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	2128 S CRYSTAL LAKE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-3307
Country	:	US
Telephone Number	:	407-454-1334
Fax Number	:

Provider Business Practice Location Address
First Line	:	2128 S CRYSTAL LAKE DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-3307
Country	:	US
Telephone Number	:	407-454-1334
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MADIHA KHAN
Credential	:
Telephone Number	:	407-454-1334

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “BRIGHTSIDE HEALTH AND WELLNESS ” Practice Location

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