Healthcare Provider Details

I. General information

NPI: 1780517177
Provider Name (Legal Business Name): OCEANLIGHT PSYCHIATRY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15381 SW 11TH ST
MIAMI FL
33194-2687
US

IV. Provider business mailing address

15381 SW 11TH ST
MIAMI FL
33194-2687
US

V. Phone/Fax

Practice location:
  • Phone: 305-219-3240
  • Fax:
Mailing address:
  • Phone: 305-219-3240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. YANET BONET GONGORA
Title or Position: OWNER
Credential: DNP, PMHNP-BC
Phone: 305-219-3240