Healthcare Provider Details

I. General information

NPI: 1144766635
Provider Name (Legal Business Name): HEALTHY MINORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 W EAU GALLIE BLVD STE 105
MELBOURNE FL
32934-3285
US

IV. Provider business mailing address

PO BOX 3065
HOUSTON TX
77253-3065
US

V. Phone/Fax

Practice location:
  • Phone: 904-750-3385
  • Fax:
Mailing address:
  • Phone: 321-684-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME94933
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME94933
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY MANDLER
Title or Position: DIRECTOR OF CONTRACTING
Credential:
Phone: 305-890-7738