Healthcare Provider Details

I. General information

NPI: 1316462690
Provider Name (Legal Business Name): VITALITY MEDICAL AND WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WARREN PKWY STE 110
FRISCO TX
75034-4273
US

IV. Provider business mailing address

5757 WARREN PKWY STE 110
FRISCO TX
75034-4273
US

V. Phone/Fax

Practice location:
  • Phone: 214-618-9622
  • Fax: 214-618-7997
Mailing address:
  • Phone: 214-618-9622
  • Fax: 214-618-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberH8208
License Number StateTX

VIII. Authorized Official

Name: MS. JENNIFER J SINOR
Title or Position: PRACTICE MANAGER
Credential:
Phone: 214-618-9622