Healthcare Provider Details

I. General information

NPI: 1932029444
Provider Name (Legal Business Name): BLUE WAVE MEDICAL SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 JIMMY BUFFETT MEMORIAL HIGHWAY STE 250
VERO BEACH FL
32963
US

IV. Provider business mailing address

5070 JIMMY BUFFETT MEMORIAL HIGHWAY STE 250
VERO BEACH FL
32963
US

V. Phone/Fax

Practice location:
  • Phone: 772-713-4111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOSH MARENDA
Title or Position: MANAGER
Credential:
Phone: 813-360-3853