Healthcare Provider Details

I. General information

NPI: 1952237745
Provider Name (Legal Business Name): TOTAL RESET MELBOURNE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 N WICKHAM RD STE 116
MELBOURNE FL
32935-2483
US

IV. Provider business mailing address

4100 N WICKHAM RD STE 116
MELBOURNE FL
32935-2483
US

V. Phone/Fax

Practice location:
  • Phone: 321-441-4975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: LEANNE DECOSIMO
Title or Position: OWNER
Credential:
Phone: 321-441-4975