=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619820479
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINDWELL PSYCHIATRY ASSOCIATESS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2026
-----------------------------------------------------
Last Update Date | 02/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 NW 170TH ST STE 105
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-503-4197
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 NW 170TH ST STE 105
-----------------------------------------------------
City | NORTH MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33169-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-503-4197
-----------------------------------------------------
Fax | 305-705-3475
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AMBR
-----------------------------------------------------
Name | DAINELIS VELAZQUEZ
-----------------------------------------------------
Credential | VELAZQUEZ
-----------------------------------------------------
Telephone | 786-503-4197
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------