Healthcare Provider Details

I. General information

NPI: 1033773346
Provider Name (Legal Business Name): SUNBELT WELLNESS INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8833 PERIMETER PARK BLVD STE 1004
JACKSONVILLE FL
32216-1114
US

IV. Provider business mailing address

8833 PERIMETER PARK BLVD STE 1004
JACKSONVILLE FL
32216-1114
US

V. Phone/Fax

Practice location:
  • Phone: 904-328-6749
  • Fax: 904-503-1960
Mailing address:
  • Phone: 904-328-6749
  • Fax: 904-503-1960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS M KALYNYCH
Title or Position: CEO MANAGING PARTNER
Credential: CRNA, APRN
Phone: 904-328-6749