| Light And Mind Wellness Llc | |
|
811 N Broad St Ste 225a Middletown DE 19709-1173 | |
| (443) 239-2033 | |
| (855) 461-3481 |
| Full Name | Light And Mind Wellness Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 811 N Broad St Ste 225a, Middletown, Delaware |
| Authorized Official Name and Position | Aisha Hassan-davis (OWNER/PROVIDER) |
| Authorized Official Contact | 4432392033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Light And Mind Wellness Llc 8707 Commerce Dr Ste E Easton MD 21601-6910 Ph: (443) 239-2033 | Light And Mind Wellness Llc 811 N Broad St Ste 225a Middletown DE 19709-1173 Ph: (443) 239-2033 |
| NPI Number | 1609449677 |
|---|---|
| Provider Enumeration Date | 07/19/2021 |
| Last Update Date | 03/01/2023 |
| Certification Date | 03/01/2023 |
| Medicare PECOS PAC ID | 1052718673 |
|---|---|
| Medicare Enrollment ID | O20210924001114 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609449677 | NPI | - | NPPES |
| 250696270 | Medicaid | DE | |
| 206453701 | Medicaid | MD |
| Provider Name | Stephane Sia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376963975 PECOS PAC ID: 7911122155 Enrollment ID: I20140711001472 |
| Provider Name | Aisha Hassan Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053951004 PECOS PAC ID: 9638585557 Enrollment ID: I20210301001712 |
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