Healthcare Provider Details

I. General information

NPI: 1306577960
Provider Name (Legal Business Name): BLUE STONE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 NW 71ST COURT, TAMARAC, FL 33321 SUITE 305
TAMARAC FL
33321
US

IV. Provider business mailing address

7710 NW 71ST CT STE 101
TAMARAC FL
33321-2930
US

V. Phone/Fax

Practice location:
  • Phone: 754-205-7619
  • Fax:
Mailing address:
  • Phone: 754-205-7619
  • 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 Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAIME K. BLAUSTEIN
Title or Position: CEO
Credential:
Phone: 754-205-7619