Healthcare Provider Details

I. General information

NPI: 1659207934
Provider Name (Legal Business Name): GREEN MERIDIAN INTEGRATIVE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 S HWY 27 STE 205F
CLERMONT FL
34711-8067
US

IV. Provider business mailing address

6433 QUARTET ST
MASCOTTE FL
34753-9319
US

V. Phone/Fax

Practice location:
  • Phone: 352-809-8709
  • Fax:
Mailing address:
  • Phone: 352-809-8709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: DR. KHANHMEI WONG
Title or Position: ACUPUNCTURE PHYSICIAN
Credential: L.AC
Phone: 352-809-8709