NPIMap

Organization Active NPI

Mandala Family Wellness LLC

  • Occupational Therapist
  • Ponte Vedra Beach, FL
National Provider Identifier
1063296754
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
MANDALA FAMILY WELLNESS LLC
Practice address
171 Canal Blvd
Ponte Vedra Beach, FL 32082-3607
Phone
(904) 834-7581
NPI assigned
Aug 23, 2023
Last updated
Aug 23, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matthew DelaneyNPI 1932489655
Title
Director of Operations and Complian
Phone
(904) 373-0082

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

171 Canal Blvd
Ponte Vedra Beach, FL 32082-3607

Mailing address

171 Canal Blvd
Ponte Vedra Beach, FL 32082-3607

National Provider Directory

National Provider Directory
Tax ID family
Mandala Family Wellness2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1692748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1063296754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 CANAL BLVD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 CANAL BLVD",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320823607",
            "telephone_number": "904-834-7581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDALA FAMILY WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-23",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "DELANEY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS AND COMPLIAN",
        "authorized_official_telephone_number": "904-373-0082"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ponte Vedra Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.