Organization
MINDBODY INTEGRATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAULIK TRIVEDI M.D. (PRESIDENT)
(813) 650-3239
Entity
Organization
Contact information
Practice address
2204 S PARSONS AVE, SEFFNER, FL 33584-5212
(813) 684-3222
(813) 464-2787
Mailing address
809 E BLOOMINGDALE AVE, PMB # 377, BRANDON, FL 33511-8113
(813) 650-3239
(813) 464-2787
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
ME 84208
FL
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
ME 84208
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
265223400
—
FL
Enumeration date
07/12/2010
Last updated
09/22/2010
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