Healthcare Provider Details

I. General information

NPI: 1518814276
Provider Name (Legal Business Name): RADIANT MINDS PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GOLD AVE SW # 1C
ALBUQUERQUE NM
87102-3119
US

IV. Provider business mailing address

2768 NW 86TH WAY
CORAL SPRINGS FL
33065-5355
US

V. Phone/Fax

Practice location:
  • Phone: 646-389-3301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDUWARD XAVIER GRANDES
Title or Position: PROVIDER
Credential: APRN
Phone: 407-718-5819