Healthcare Provider Details

I. General information

NPI: 1649154923
Provider Name (Legal Business Name): MINDBRIDGE TELEHEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST # 4991
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

1111 OCEAN ST UNIT 204
SANTA CRUZ CA
95060-2898
US

V. Phone/Fax

Practice location:
  • Phone: 408-896-0894
  • Fax:
Mailing address:
  • Phone: 408-896-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MONIKA ZOFIA DELYSER
Title or Position: OWNER / NURSE PRACTITIONER
Credential: PMHNP-BC
Phone: 408-896-0894