Healthcare Provider Details

I. General information

NPI: 1043126881
Provider Name (Legal Business Name): BIO AESTHETICS & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 W MAIN ST STE 100
FLEETWOOD PA
19522-1315
US

IV. Provider business mailing address

46 W MAIN ST STE 100
FLEETWOOD PA
19522-1315
US

V. Phone/Fax

Practice location:
  • Phone: 484-273-0809
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JEMIKA SIVAK
Title or Position: OWNER
Credential: FNP-BC
Phone: 484-273-0809