Healthcare Provider Details

I. General information

NPI: 1063170124
Provider Name (Legal Business Name): MINDFUL MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/12/2022
Certification Date: 12/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 W PALMETTO PARK RD STE 406
BOCA RATON FL
33433-3425
US

IV. Provider business mailing address

7000 W PALMETTO PARK RD STE 406
BOCA RATON FL
33433-3425
US

V. Phone/Fax

Practice location:
  • Phone: 844-986-4325
  • Fax:
Mailing address:
  • Phone: 844-986-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. BARRY DAVID PESKIN
Title or Position: CEO/ MEDICAL DIRECTOR
Credential: MD
Phone: 216-973-2844