Healthcare Provider Details

I. General information

NPI: 1396590659
Provider Name (Legal Business Name): MIND REFINED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3191 CORAL WAY STE 607
MIAMI FL
33145-3230
US

IV. Provider business mailing address

14649 SW 42ND ST, PMB 134
MIAMI FL
33175-7825
US

V. Phone/Fax

Practice location:
  • Phone: 305-290-2176
  • Fax: 305-290-2176
Mailing address:
  • Phone: 305-290-2175
  • Fax: 305-290-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE ANDREA VON DER HEYDE
Title or Position: CEO
Credential: NP
Phone: 305-290-2175