MEDICARE: TOTAL WELLNESS 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	133V00000X	Registered Dietitian	000691-1	NY

General Provider Information

NPI Number	:	1699826263
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL WELLNESS INC

Provider Business Mailing Address
First Line	:	160 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5320
Country	:	US
Telephone Number	:	631-666-4297
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 HOWELLS RD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-5320
Country	:	US
Telephone Number	:	631-666-4297
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARLISA BROWN
Credential	:	MS RD CDE CDN
Telephone Number	:	631-666-4297

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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Directions to “TOTAL WELLNESS INC ” Practice Location

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