MEDICARE: SOUTH FLORIDA WELLNESS NETWORK, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1336504786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH FLORIDA WELLNESS NETWORK, INC

Provider Business Mailing Address
First Line	:	2901 W CYPRESS CREEK RD STE 105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1730
Country	:	US
Telephone Number	:	954-533-0585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2901 W CYPRESS CREEK RD STE 105
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1730
Country	:	US
Telephone Number	:	954-533-0585
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MRS. SUSAN NYAMORA
Credential	:
Telephone Number	:	954-629-0405

Provider Enumeration Date	:	12/29/2015
Last Update Date	:	04/13/2017

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