Healthcare Provider Details

I. General information

NPI: 1194640326
Provider Name (Legal Business Name): AURA MENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 SUN CITY CENTER PLZ
SUN CITY CENTER FL
33573-5373
US

IV. Provider business mailing address

1647 SUN CITY CENTER PLZ
SUN CITY CENTER FL
33573-5373
US

V. Phone/Fax

Practice location:
  • Phone: 813-803-2237
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REGINE A
Title or Position: FOUNDER
Credential:
Phone: 917-536-0254