Healthcare Provider Details

I. General information

NPI: 1790248466
Provider Name (Legal Business Name): WAVES OF WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SE CENTRAL PKWY STE 225
STUART FL
34994-5920
US

IV. Provider business mailing address

10 SE CENTRAL PKWY STE 225
STUART FL
34994-5920
US

V. Phone/Fax

Practice location:
  • Phone: 570-242-1768
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY CAMAEREI
Title or Position: DIRECTOR OF LICENSING
Credential: MBA
Phone: 570-242-1768