Healthcare Provider Details

I. General information

NPI: 1104397595
Provider Name (Legal Business Name): MELLOW KIDS, PLLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 NE 4TH ST STE A
DELRAY BEACH FL
33444-3805
US

IV. Provider business mailing address

4350 POST AVE
MIAMI BEACH FL
33140-3012
US

V. Phone/Fax

Practice location:
  • Phone: 786-521-1587
  • Fax:
Mailing address:
  • Phone: 786-521-1587
  • Fax: 786-275-6916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERSHON FINK
Title or Position: PRESIDENT
Credential: DO
Phone: 786-521-1587