Healthcare Provider Details

I. General information

NPI: 1073338307
Provider Name (Legal Business Name): MIAMI MENTAL HEALTH & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 SUNSET DR STE 105
MIAMI FL
33173-4648
US

IV. Provider business mailing address

9835 SUNSET DR STE 105
MIAMI FL
33173-4648
US

V. Phone/Fax

Practice location:
  • Phone: 786-937-9835
  • Fax: 786-937-9834
Mailing address:
  • Phone: 786-937-9835
  • Fax: 786-937-9834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: YANISLEIDY MONDEJA
Title or Position: OWNER
Credential:
Phone: 305-909-0626