=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790621084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LUMINA NP IN PSYCHIATRY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2026
-----------------------------------------------------
Last Update Date | 04/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 230 HILTON AVE STE 4
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-8116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-774-1616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 175 CIRCLE DR E
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-2115
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-774-1616
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SOPHIA VERELLA
-----------------------------------------------------
Credential | PMHNP
-----------------------------------------------------
Telephone | 517-774-1616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------