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General NPI Number Information
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NPI Number | 1568146967
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Entity Type | Organization
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Legal Business Name | BRIGHTSIDE HEALTH AND WELLNESS
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 2128 S CRYSTAL LAKE DR
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City | ORLANDO
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State | FL
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Zip | 32806-3307
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Country | US
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Telephone | 407-454-1334
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Fax |
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Provider Business Mailing Address
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Address Line | 2128 S CRYSTAL LAKE DR
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City | ORLANDO
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State | FL
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Zip | 32806-3307
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Country | US
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Telephone | 407-454-1334
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MADIHA KHAN
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Credential |
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Telephone | 407-454-1334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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