Healthcare Provider Details

I. General information

NPI: 1437605789
Provider Name (Legal Business Name): SOUTHERN HEALTH AND WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302ALTON ROAD SUITE 470
MIAMI BEACH FL
33140-4557
US

IV. Provider business mailing address

4302 ALTON ROAD SUITE 470
MIAMI BEACH FL
33140-4557
US

V. Phone/Fax

Practice location:
  • Phone: 786-447-9726
  • Fax: 305-397-8889
Mailing address:
  • Phone: 786-509-9980
  • Fax: 305-397-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME120723
License Number StateFL

VIII. Authorized Official

Name: DR. PAMELA NICOLE TROTTER
Title or Position: DOCTOR
Credential: MD
Phone: 786-509-9980