Healthcare Provider Details

I. General information

NPI: 1093644296
Provider Name (Legal Business Name): MINDFUL AMITY PSYCHOLOGICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 SW 97TH AVE STE 105
MIAMI FL
33173-1407
US

IV. Provider business mailing address

7001 SW 97TH AVE STE 105
MIAMI FL
33173-1407
US

V. Phone/Fax

Practice location:
  • Phone: 305-972-5564
  • Fax:
Mailing address:
  • Phone: 305-972-5564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. AILYN PAYAN
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 305-972-5564