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General NPI Number Information
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NPI Number | 1174496418
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Entity Type | Organization
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Legal Business Name | WAY CONCIERGE MEDICINE LLC
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Dates
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Enumeration Date | 09/24/2025
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Last Update Date | 09/24/2025
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Provider Practice Location Address
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Address Line | 8131 LAKEWOOD MAIN ST STE 205
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5060
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Country | US
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Telephone | 860-970-1303
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Fax | 941-344-0621
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Provider Business Mailing Address
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Address Line | 8131 LAKEWOOD MAIN ST STE 205
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-5060
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Country | US
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Telephone | 860-970-1303
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Fax | 941-344-0621
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Authorized Official
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Title or Position | OWNER
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Name | ANDRE DE SOUZA E MELO
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Credential | MD
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Telephone | 860-970-1303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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