MEDICARE: INTEGRATIVE PSYCHIATRY AND WHOLE BODY 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
2	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1427981406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE PSYCHIATRY AND WHOLE BODY WELLNESS, LLC

Provider Business Mailing Address
First Line	:	1779 HARBORSIDE CIR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8068
Country	:	US
Telephone Number	:	561-670-0243
Fax Number	:

Provider Business Practice Location Address
First Line	:	1779 HARBORSIDE CIR
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-8068
Country	:	US
Telephone Number	:	561-670-0243
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HADRY CHARYLL DIAZ
Credential	:	APRN FNP-C, PMHNP-BC
Telephone Number	:	561-670-0243

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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