Provider Demographics
NPI:1649046467
Name:PEACEFUL MIND NURSE PRACTITIONER IN PSYCHIATRY PC
Entity type:Organization
Organization Name:PEACEFUL MIND NURSE PRACTITIONER IN PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAKINA
Authorized Official - Middle Name:STARR
Authorized Official - Last Name:HAYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:630-609-0872
Mailing Address - Street 1:1488 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1208
Mailing Address - Country:US
Mailing Address - Phone:646-434-6238
Mailing Address - Fax:
Practice Address - Street 1:335 S WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4906
Practice Address - Country:US
Practice Address - Phone:631-609-0562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty