MEDICARE: VITALITY HEALTH & WELLNESS LLC

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	174400000X	Specialist	ME75290	FL
2	175F00000X	Naturopath	ME75290	FL
3	2084P0800X	Psychiatry Physician	ME75290	FL
4	2084P0804X	Child & Adolescent Psychiatry Physician	ME75290	FL
5	208D00000X	General Practice Physician	ME75290	FL

General Provider Information

NPI Number	:	1922488675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	801 4TH STREET
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-6823
Country	:	US
Telephone Number	:	305-466-1100
Fax Number	:	305-466-1160

Provider Business Practice Location Address
First Line	:	801 4TH STREET
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-6823
Country	:	US
Telephone Number	:	305-466-1100
Fax Number	:	305-466-1160

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MS. MELANIE SCHRADER
Credential	:
Telephone Number	:	305-466-1100

Provider Enumeration Date	:	06/08/2015
Last Update Date	:	06/08/2015

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