Provider Demographics
NPI:1932096914
Name:MIND FULL OF WELLNES, LLC
Entity type:Organization
Organization Name:MIND FULL OF WELLNES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PERRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN-ARNP-PMHNP-BC
Authorized Official - Phone:561-441-1158
Mailing Address - Street 1:15707 COLLECTING CANAL RD
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4235
Mailing Address - Country:US
Mailing Address - Phone:561-441-1158
Mailing Address - Fax:
Practice Address - Street 1:15707 COLLECTING CANAL RD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4235
Practice Address - Country:US
Practice Address - Phone:561-441-1158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-21
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty