=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881355436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIND SOUL WELLNESS OF FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2022
-----------------------------------------------------
Last Update Date | 01/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9387 BOCA RIVER CIR
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33434-3973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-695-6756
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 146 NORTH ST
-----------------------------------------------------
City | STONEHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02180-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-367-2692
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GABRIEL ROBERT DONADIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-367-2692
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------