Healthcare Provider Details

I. General information

NPI: 1124678842
Provider Name (Legal Business Name): PEACE OF MIND MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2019
Last Update Date: 09/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 S BOULEVARD
TAMPA FL
33606-2629
US

IV. Provider business mailing address

1512 E 12TH AVE UNIT 357
TAMPA FL
33605-3576
US

V. Phone/Fax

Practice location:
  • Phone: 646-919-5995
  • Fax: 813-609-6051
Mailing address:
  • Phone: 718-669-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEKSANDR ZVERINSKIY
Title or Position: PRESIDENT
Credential: MD
Phone: 718-669-0956