Healthcare Provider Details

I. General information

NPI: 1750128310
Provider Name (Legal Business Name): SYGNITY WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4365 NORTHLAKE BLVD
PALM BEACH GARDENS FL
33410-6253
US

IV. Provider business mailing address

PO BOX 31419
PALM BEACH GARDENS FL
33420-1419
US

V. Phone/Fax

Practice location:
  • Phone: 561-401-7498
  • Fax:
Mailing address:
  • Phone: 561-401-7498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS MELANIE WERNER
Title or Position: CORPORATE DEVELOPMENT OFFICER
Credential:
Phone: 561-401-7498