Healthcare Provider Details

I. General information

NPI: 1518885136
Provider Name (Legal Business Name): SHALOM BEHAVIORAL WELLNESS CENTER LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 COLONIAL BLVD STE 102
FORT MYERS FL
33907-1025
US

IV. Provider business mailing address

1500 COLONIAL BLVD STE 102
FORT MYERS FL
33907-1025
US

V. Phone/Fax

Practice location:
  • Phone: 786-296-5701
  • Fax:
Mailing address:
  • Phone: 786-296-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: YULEYSI ALVAREZ GANDARA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 786-296-5701