Healthcare Provider Details

I. General information

NPI: 1114835501
Provider Name (Legal Business Name): MAX-WELLNESS ADVANCED PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SUMMER ST STE 4
STAMFORD CT
06901-2304
US

IV. Provider business mailing address

320 S BROADWAY UNIT M5
TARRYTOWN NY
10591-5403
US

V. Phone/Fax

Practice location:
  • Phone: 914-312-7063
  • Fax:
Mailing address:
  • Phone:
  • 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: MAXWELL OPOKU KORANTENG
Title or Position: OWNER
Credential: PMHNP
Phone: 914-312-7063