Healthcare Provider Details

I. General information

NPI: 1700723285
Provider Name (Legal Business Name): HYDROPOLIS LOUNGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 GATEWAY BLVD STE 108
BOYNTON BEACH FL
33426-8309
US

IV. Provider business mailing address

1054 GATEWAY BLVD STE 108
BOYNTON BEACH FL
33426-8309
US

V. Phone/Fax

Practice location:
  • Phone: 561-791-6241
  • Fax: 561-335-3364
Mailing address:
  • Phone: 561-791-6241
  • Fax: 561-335-3364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDRA TAYLOR BLAKELY
Title or Position: OWNER
Credential: MD
Phone: 954-598-4215