Healthcare Provider Details

I. General information

NPI: 1669317004
Provider Name (Legal Business Name): BRIGHTS MINDS BLOOM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ELMWOOD PARK DR APT 713
STATEN ISLAND NY
10314-7530
US

IV. Provider business mailing address

2 ELMWOOD PARK DR APT 713
STATEN ISLAND NY
10314-7530
US

V. Phone/Fax

Practice location:
  • Phone: 347-401-1844
  • Fax: 347-401-1844
Mailing address:
  • Phone: 347-401-1844
  • Fax: 347-401-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. SVETLANA SHPITALNIK
Title or Position: PRESIDENT
Credential:
Phone: 347-401-1844