Organization
OPTIMISTIC WELLNESS LLC
Active
Other names
Consumer Protection Law, Dequan' Dr. Dequan'
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHELDON B HAYNES M.D. (CONSULTANT)
(785) 817-1893
Entity
Organization
Contact information
Practice address
5119 NW KENDALL CT, TOPEKA, KS 66618-1269
(785) 817-1893
(785) 587-0009
Mailing address
5119 NW KENDALL CT, TOPEKA, KS 66618-1269
(785) 817-1893
(785) 578-0009
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
—
—
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
247000000X
Health Information Technician
—
—
251B00000X
Case Management Agency
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH5617545
DEA
KS
05
—
BH5617545
—
KS
01
—
KS-ASCX12N
OLD LICENCE
KS
05
—
KS04-64104
—
KS
Enumeration date
11/06/2023
Last updated
12/12/2024
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