Provider Demographics
NPI:1265671184
Name:MIND WELLNESS PROFESSIONAL PSYCHIATRIC SERVICES PC
Entity Type:Organization
Organization Name:MIND WELLNESS PROFESSIONAL PSYCHIATRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSHAFEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-238-6161
Mailing Address - Street 1:6903 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1509
Mailing Address - Country:US
Mailing Address - Phone:718-238-6161
Mailing Address - Fax:
Practice Address - Street 1:6903 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1509
Practice Address - Country:US
Practice Address - Phone:718-238-6161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2492112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty