MEDICARE: SERENEMIND NP IN ADULT HEALTH &PSYCHIATRY PLLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1376494963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENEMIND NP IN ADULT HEALTH &PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	1211 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1945
Country	:	US
Telephone Number	:	631-260-2280
Fax Number	:	631-350-0570

Provider Business Practice Location Address
First Line	:	1211 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-1945
Country	:	US
Telephone Number	:	631-260-2280
Fax Number	:	631-350-0570

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DR. NICOLE LOUIS BEAUBRUN
Credential	:	DNP
Telephone Number	:	631-260-2280

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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