Healthcare Provider Details

I. General information

NPI: 1720886062
Provider Name (Legal Business Name): EVOLVING MIND INTEGRATIVE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 MUNICIPAL DR STE 200 OFFICE 225
FISHERS IN
46038-1634
US

IV. Provider business mailing address

1800 HAZELWOOD AVE STE 5009
FORT WAYNE IN
46805-7514
US

V. Phone/Fax

Practice location:
  • Phone: 301-503-7758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINITA PRASAD
Title or Position: PSYCHIATRIST
Credential: MD
Phone: 301-503-7758