MEDICARE: SENIOR SOLUTIONS MIND & BODY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0805X	Geriatric Psychiatry Physician
2	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1013712827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR SOLUTIONS MIND & BODY, LLC

Provider Business Mailing Address
First Line	:	5835 BRABROOK AVE
Second Line	:
City	:	GRANT VALKARIA
State	:	FL
Zip	:	32949-2130
Country	:	US
Telephone Number	:	321-249-2677
Fax Number	:

Provider Business Practice Location Address
First Line	:	1344 S APOLLO BLVD STE 2C
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3183
Country	:	US
Telephone Number	:	321-249-2677
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TAMI LEEBERG
Credential	:	AGPCNP
Telephone Number	:	321-249-2677

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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