NPIMap

Organization Active NPI

Animo Sano Psychiatry PLLC

  • Psychiatry Physician
  • Durham, NC
National Provider Identifier
1568043537
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ANIMO SANO PSYCHIATRY PLLC
Practice address
5501 Fortunes Ridge Dr Ste P
Durham, NC 27713-6102
Phone
(919) 391-7202
Fax
(919) 391-7203
NPI assigned
Apr 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Authorized official

Name
Dr. Mina Boazak, MDNPI 1104209329
Title
Founder and Medical Director
Phone
(919) 391-7202

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

5501 Fortunes Ridge Dr Ste P
Durham, NC 27713-6102

Mailing address

5501 Fortunes Ridge Dr Ste P
Durham, NC 27713-6102
Phone (919) 391-7202

Other practice location 1

1601 5th Ave Ste 900
Seattle, WA 98101-3621
Phone (919) 391-7202

Other practice location 2

555 SE Mlk Jr Blvd Unit 105
Portland, OR 97214-2595
Phone (919) 391-7202

Other practice location 3

100 S 4th St Ste 550
Saint Louis, MO 63102-1800
Phone (919) 391-7202

Other practice location 4

201 Robert S Kerr Ave Ste 700
Oklahoma City, OK 73102-4203
Phone (919) 391-7202

Other practice location 5

64 E Broadway Rd Ste 200
Tempe, AZ 85282-1377
Phone (919) 391-7202

Other practice location 6

510 Clinton Sq Ofc 509
Rochester, NY 14604-1700
Phone (919) 391-7202

Other practice location 7

1202 NE McClain Rd Bldg 7
Bentonville, AR 72712-3875
Phone (919) 391-7202

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, GA, TN, NY, AZ, AR, OK, WA, MO9 enrollments

Enrollment records 9

Enrollment IDStateProvider typePAC IDDetails
O20210623002788 NC Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 72 practitioners
Practice locations: Durham, NC
O20231219000129 GA Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 8 practitioners
Practice locations: Atlanta, GA; Marietta, GA
O20240116002801 TN Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 6 practitioners
Practice locations: Knoxville, TN
O20240401001483 NY Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 4 practitioners
Practice locations: Rochester, NY
O20250219003356 AZ Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 2 practitioners
Practice locations: Tempe, AZ
O20250227003925 AR Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 3 practitioners
Practice locations: Bentonville, AR
O20250228003273 OK Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 4 practitioners
Practice locations: Oklahoma City, OK
O20250508003032 WA Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 2 practitioners
Practice locations: Seattle, WA
O20250509001552 MO Part B Supplier - Clinic/Group Practice 8729489182 Receives reassigned benefits from 5 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

45 South Ave SE
Ste 5
Marietta, GA 30060

100 S 4th St
Ofc 552
Saint Louis, MO 63102

2530 Meridian Pkwy
Ste 3048
Durham, NC 27713

2530 Meridian Pkwy
Ofc 3048
Durham, NC 27713

510 Clinton Sq
Ofc 509
Rochester, NY 14604

1601 5th Ave
Ste 900
Seattle, WA 98101
Phone (954) 716-2424

Practitioners & affiliated clinicians

Practitioners 86

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765929600000",
    "number": "1568043537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 FORTUNES RIDGE DR STE P",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277136102",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 FORTUNES RIDGE DR STE P",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277136102",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1601 5th Ave Ste 900",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981013621",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "555 SE Mlk Jr Blvd Unit 105",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972142595",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 S 4th St Ste 550",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631021800",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 Robert S Kerr Ave Ste 700",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731024203",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "64 E Broadway Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Tempe",
            "state": "AZ",
            "postal_code": "852821377",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "510 Clinton Sq Ofc 509",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146041700",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1202 NE McClain Rd Bldg 7",
            "address_purpose": "LOCATION",
            "city": "Bentonville",
            "state": "AR",
            "postal_code": "727123875",
            "country_code": "US",
            "telephone_number": "919-391-7202",
            "fax_number": "919-391-7203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANIMO SANO PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A",
        "authorized_official_last_name": "BOAZAK",
        "authorized_official_first_name": "MINA",
        "authorized_official_title_or_position": "FOUNDER AND MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "919-391-7202",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.