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General NPI Number Information
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NPI Number | 1255295341
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE AESTHETICS AND WELLNESS
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 16915 SCUBA CREST ST
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City | WIMAUMA
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State | FL
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Zip | 33598-2519
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Country | US
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Telephone | 941-334-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 16915 SCUBA CREST ST
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City | WIMAUMA
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State | FL
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Zip | 33598-2519
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Country | US
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Telephone | 941-334-3077
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Fax |
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Authorized Official
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Title or Position | OWNER/PA-C
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Name | JAMES DAVIS
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Credential | PA-C
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Telephone | 901-201-1963
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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