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MINDGLOW PSYCHIATRY PLLC - Florida Company Profile

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Company Details

Entity Name: MINDGLOW PSYCHIATRY PLLC
Jurisdiction: FLORIDA
Filing Type: Florida Limited Liability Co.
Status: Active
Date Filed: 14 Feb 2025 (6 months ago)
Document Number: L25000077839
Address: 10315 SW 181ST STREET, MIAMI, FL, 33157, US
Mail Address: 10315 SW 181ST STREET, MIAMI, FL, 33157, US
ZIP code: 33157
City: Miami
County: Miami-Dade
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
NEWMAN TAYLOR Agent 7901 4TH ST N STE, ST. PETERSBURG, FL, 33702
DARST ALEXANDRA Authorized Representative 2336 W RICE ST, CHICAGO, IL, 60622
MBANUGO OBUNADIKE Chief Executive Officer 10315 SW 181ST STREET, MIAMI, FL, 33157

National Provider Identifier

NPI Number:
1629875711
Certification Date:
2025-02-26

Authorized Person:

Name:
OBUNADIKE MBANUGO
Role:
CEO
Phone:

Taxonomy:

Selected Taxonomy:
363LP0808X - Psychiatric/Mental Health Nurse Practitioner
Is Primary:
Yes

Contacts:

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Date of last update: 03 Aug 2025

Sources: Florida Department of State