Healthcare Provider Details

I. General information

NPI: 1669265815
Provider Name (Legal Business Name): SERENITY SHIFT WELLNESS CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 HOLLYWOOD BLVD STE 701
HOLLYWOOD FL
33020-6628
US

IV. Provider business mailing address

2450 HOLLYWOOD BLVD STE 701
HOLLYWOOD FL
33020-6628
US

V. Phone/Fax

Practice location:
  • Phone: 786-226-2679
  • Fax: 954-416-7437
Mailing address:
  • Phone: 786-226-2679
  • Fax: 954-416-7437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. STEPHANIE CORBO
Title or Position: APRN, OWNER
Credential: APRN
Phone: 469-638-3162