MEDICARE: NURTURE MIND NP IN PSYCHIATRY, P.C.

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	:	1396690467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURTURE MIND NP IN PSYCHIATRY, P.C.

Provider Business Mailing Address
First Line	:	7 GATES AVE
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-5911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 GATES AVE
Second Line	:
City	:	PLAINVIEW
State	:	NY
Zip	:	11803-5911
Country	:	US
Telephone Number	:	347-813-1957
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT SHIMONOV
Credential	:	NP
Telephone Number	:	347-813-1957

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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