=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154232122
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERENITY PEDIATRIC WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2026
-----------------------------------------------------
Last Update Date | 09/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1351 ALAFAYA TRL STE 1005
-----------------------------------------------------
City | OVIEDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32765-9100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-323-7336
-----------------------------------------------------
Fax | 321-516-8350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1351 ALAFAYA TRL STE 1005
-----------------------------------------------------
City | OVIEDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32765-9100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-323-7336
-----------------------------------------------------
Fax | 321-516-8350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. IRISSA ROSARIO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 407-484-5241
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------