Healthcare Provider Details

I. General information

NPI: 1891660676
Provider Name (Legal Business Name): MYNDFL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 BETHESDA PL
WINSTON SALEM NC
27103-3318
US

IV. Provider business mailing address

333 SKOKIE BLVD STE 101
NORTHBROOK IL
60062-1621
US

V. Phone/Fax

Practice location:
  • Phone: 708-232-6580
  • Fax:
Mailing address:
  • Phone: 708-232-6580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: SHARI KALIK-MILLER
Title or Position: PRESIDENT
Credential:
Phone: 708-232-6580