MEDICARE: BLUE STONE WELLNESS 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	261QH0100X	Health Service Clinic/Center
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1306577960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE STONE WELLNESS LLC

Provider Business Mailing Address
First Line	:	7710 NW 71ST CT STE 101
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-2930
Country	:	US
Telephone Number	:	754-205-7619
Fax Number	:

Provider Business Practice Location Address
First Line	:	7710 NW 71ST COURT, TAMARAC, FL 33321
Second Line	:	SUITE 305
City	:	TAMARAC
State	:	FL
Zip	:	33321
Country	:	US
Telephone Number	:	754-205-7619
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAIME K. BLAUSTEIN
Credential	:
Telephone Number	:	754-205-7619

Provider Enumeration Date	:	06/23/2022
Last Update Date	:	03/19/2026

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Directions to “BLUE STONE WELLNESS LLC ” Practice Location

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