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General NPI Number Information
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NPI Number | 1518814276
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Entity Type | Organization
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Legal Business Name | RADIANT MINDS PSYCHIATRY LLC
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Dates
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Enumeration Date | 03/12/2026
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Last Update Date | 03/12/2026
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Provider Practice Location Address
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Address Line | 295 MADISON AVE FL 12
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City | NEW YORK
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State | NY
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Zip | 10017-6379
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Country | US
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Telephone | 646-389-3301
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Fax |
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Provider Business Mailing Address
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Address Line | 2768 NW 86TH WAY
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-5355
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | EDUWARD XAVIER GRANDES
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Credential | APRN
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Telephone | 407-718-5819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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