MEDICARE: MINDWELL PSYCHIATRY ASSOCIATES 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	163WP0808X	Psychiatric/Mental Health Registered Nurse

General Provider Information

NPI Number	:	1619820479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDWELL PSYCHIATRY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	100 NW 170TH ST STE 105
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-5510
Country	:	US
Telephone Number	:	786-936-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 NW 170TH ST STE 105
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33169-5510
Country	:	US
Telephone Number	:	786-936-6262
Fax Number	:

Authorized Official
Title or Position	:	AMBR
Name	:	DAINELIS VELAZQUEZ
Credential	:
Telephone Number	:	786-602-8900

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	06/08/2026

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