MEDICARE: SHIELDED MINDS 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1104328327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELDED MINDS LLC

Provider Business Mailing Address
First Line	:	2690 AFRICAN VIOLET AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1957
Country	:	US
Telephone Number	:	813-409-1851
Fax Number	:

Provider Business Practice Location Address
First Line	:	2690 AFRICAN VIOLET AVE
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-1957
Country	:	US
Telephone Number	:	813-409-1851
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	ANASTACIA MARIA ARCE
Credential	:
Telephone Number	:	813-409-1851

Provider Enumeration Date	:	03/03/2018
Last Update Date	:	03/03/2018

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Directions to “SHIELDED MINDS LLC ” Practice Location

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