Healthcare Provider Details

I. General information

NPI: 1821943234
Provider Name (Legal Business Name): LOTUS WELLNESS AND INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 MCGARVEY CT
MYRTLE BEACH SC
29579-3610
US

IV. Provider business mailing address

807 MCGARVEY COURT
MYRTLE BEAC SC
29579
US

V. Phone/Fax

Practice location:
  • Phone: 631-245-9799
  • Fax:
Mailing address:
  • Phone: 631-245-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELE C CAIETTA
Title or Position: PHYSICIAN ASSISTANT
Credential: PA
Phone: 631-245-9799