Healthcare Provider Details

I. General information

NPI: 1174449599
Provider Name (Legal Business Name): SOUTHDADE WELLNESS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 SW 8TH ST STE 105
MIAMI FL
33144-4100
US

IV. Provider business mailing address

8300 SW 8TH ST STE 105
MIAMI FL
33144-4100
US

V. Phone/Fax

Practice location:
  • Phone: 786-542-5794
  • Fax: 786-542-5830
Mailing address:
  • Phone: 786-542-5794
  • Fax: 786-542-5830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: SEIDEL NARANJO VELEZ
Title or Position: OWNER
Credential:
Phone: 786-886-6108