Mindbody Integrated

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

ME 84208 Issued in FL

Legal business name

MINDBODY INTEGRATED

Practice address

2204 S Parsons Ave
Seffner, FL 33584-5212

Phone

(813) 684-3222

Fax

(813) 464-2787

NPI assigned

Jul 12, 2010

Last updated

Sep 22, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Maulik Trivedi, M.D.

Title

President

Phone

(813) 650-3239

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1278892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285113600000",
    "number": "1225340789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 E BLOOMINGDALE AVE",
            "address_2": "PMB # 377",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118113",
            "telephone_number": "813-650-3239",
            "fax_number": "813-464-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 S PARSONS AVE",
            "city": "SEFFNER",
            "state": "FL",
            "postal_code": "335845212",
            "telephone_number": "813-684-3222",
            "fax_number": "813-464-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINDBODY INTEGRATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-12",
        "last_updated": "2010-09-22",
        "status": "A",
        "authorized_official_last_name": "TRIVEDI",
        "authorized_official_first_name": "MAULIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-650-3239",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME 84208",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "FL",
            "license": "ME 84208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "265223400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Seffner, FL by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2010; 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.