Healthcare Provider Details

I. General information

NPI: 1407397540
Provider Name (Legal Business Name): RE3 STEM CELL AND HEALING INSTITUTE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 FRUITVILLE RD
SARASOTA FL
34237-9026
US

IV. Provider business mailing address

3532 FRUITVILLE RD
SARASOTA FL
34237-9026
US

V. Phone/Fax

Practice location:
  • Phone: 941-893-2688
  • Fax: 941-893-2690
Mailing address:
  • Phone: 941-893-2688
  • Fax: 941-893-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HUAN WANG
Title or Position: MANAGER
Credential: MD
Phone: 941-893-2688