Healthcare Provider Details

I. General information

NPI: 1528836376
Provider Name (Legal Business Name): OMAHA MINDFUL MEDICINE AND THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S 11TH ST
OMAHA NE
68108-1014
US

IV. Provider business mailing address

8054 MARTHA ST
OMAHA NE
68124-2247
US

V. Phone/Fax

Practice location:
  • Phone: 402-591-0334
  • Fax:
Mailing address:
  • Phone: 402-591-0334
  • 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 Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SUPRIYA BHATIA
Title or Position: OWNER
Credential: M.D.
Phone: 402-591-0334