MEDICARE: MINDFUL CONNECTIONS PSYCHIATRY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker
3	363AM0700X	Medical Physician Assistant
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
5	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1801674106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL CONNECTIONS PSYCHIATRY PLLC

Provider Business Mailing Address
First Line	:	2372 SWEET HOME RD STE 3
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-2330
Country	:	US
Telephone Number	:	716-389-3267
Fax Number	:	716-639-1382

Provider Business Practice Location Address
First Line	:	8203 MAIN ST STE 2
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-6051
Country	:	US
Telephone Number	:	716-219-3636
Fax Number	:	716-209-3680

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BISWARUP MANOJKUMAR GHOSH
Credential	:
Telephone Number	:	716-219-3636

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	11/04/2024

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