Healthcare Provider Details

I. General information

NPI: 1174181572
Provider Name (Legal Business Name): WELLNESS TREASURE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 05/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 GRAND BLVD
NEW PORT RICHEY FL
34652-4014
US

IV. Provider business mailing address

5319 GRAND BLVD
NEW PORT RICHEY FL
34652-4014
US

V. Phone/Fax

Practice location:
  • Phone: 727-220-2344
  • Fax:
Mailing address:
  • Phone: 727-220-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID SHERMAN
Title or Position: OWNER
Credential: MD
Phone: 727-220-2344