| Brain Spa De Llc | |
|
410 Foulk Rd Ste 105 Wilmington DE 19803-3835 | |
| (302) 312-9478 | |
| Not Available |
| Full Name | Brain Spa De Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 410 Foulk Rd Ste 105, Wilmington, Delaware |
| Authorized Official Name and Position | Sandeep Gupta (OWNER) |
| Authorized Official Contact | 3024786199 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brain Spa De Llc 1 Harbison Way Columbia SC 29212-3422 Ph: (803) 768-4348 | Brain Spa De Llc 410 Foulk Rd Ste 105 Wilmington DE 19803-3835 Ph: (302) 312-9478 |
| NPI Number | 1861081499 |
|---|---|
| Provider Enumeration Date | 01/18/2021 |
| Last Update Date | 01/18/2021 |
| Certification Date | 01/18/2021 |
| Medicare PECOS PAC ID | 0840607511 |
|---|---|
| Medicare Enrollment ID | O20210324001997 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861081499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sandeep K Gupta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1972577005 PECOS PAC ID: 8224928874 Enrollment ID: I20040729000653 |
| Provider Name | Janet M Brown |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1043290638 PECOS PAC ID: 2668541830 Enrollment ID: I20080514000833 |
| Provider Name | Michelle Lauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013483627 PECOS PAC ID: 1153666714 Enrollment ID: I20181231000947 |
| Provider Name | Gobind Kang-chahal |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265533392 PECOS PAC ID: 2668464199 Enrollment ID: I20230124003310 |
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