Healthcare Provider Details

I. General information

NPI: 1508722612
Provider Name (Legal Business Name): EASEWELL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 ALLIGATOR LAKE RD
SAINT CLOUD FL
34772-9320
US

IV. Provider business mailing address

5370 ALLIGATOR LAKE RD
SAINT CLOUD FL
34772-9320
US

V. Phone/Fax

Practice location:
  • Phone: 407-505-8484
  • Fax:
Mailing address:
  • Phone: 407-505-8484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANY VALLADARES
Title or Position: CEO
Credential:
Phone: 407-505-8484