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General NPI Number Information
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NPI Number | 1396590659
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Entity Type | Organization
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Legal Business Name | MIND REFINED
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Dates
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Enumeration Date | 04/20/2024
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 3191 CORAL WAY STE 607
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City | MIAMI
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State | FL
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Zip | 33145-3230
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Country | US
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Telephone | 305-290-2176
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Fax | 305-290-2176
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Provider Business Mailing Address
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Address Line | 14649 SW 42ND ST, PMB 134
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City | MIAMI
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State | FL
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Zip | 33175-7825
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Country | US
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Telephone | 305-290-2175
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Fax | 305-290-2176
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Authorized Official
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Title or Position | CEO
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Name | MICHELLE ANDREA VON DER HEYDE
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Credential | NP
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Telephone | 305-290-2175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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