Healthcare Provider Details

I. General information

NPI: 1790621084
Provider Name (Legal Business Name): LUMINA NP IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 HILTON AVE STE 4
HEMPSTEAD NY
11550-8116
US

IV. Provider business mailing address

175 CIRCLE DR E
ELMONT NY
11003-2115
US

V. Phone/Fax

Practice location:
  • Phone: 517-774-1616
  • Fax:
Mailing address:
  • Phone: 517-774-1616
  • 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: SOPHIA VERELLA
Title or Position: OWNER
Credential: PMHNP
Phone: 517-774-1616