Healthcare Provider Details

I. General information

NPI: 1417898164
Provider Name (Legal Business Name): CBA ELITE MIND & BODY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1142 SW SUDDER AVE
PORT SAINT LUCIE FL
34953-1419
US

IV. Provider business mailing address

1729 NW SAINT LUCIE WEST BLVD # 1253
PORT SAINT LUCIE FL
34986-2501
US

V. Phone/Fax

Practice location:
  • Phone: 413-745-3149
  • Fax:
Mailing address:
  • Phone: 413-735-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CLAUDY BONNE ANNEE
Title or Position: MD
Credential: MD, APRN, PMHNP-BC
Phone: 413-735-3149