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General NPI Number Information
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NPI Number | 1275811770
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Entity Type | Organization
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Legal Business Name | TOTAL WELLNESS & HEALTHY AGING FOUNDATION INC
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Dates
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Enumeration Date | 08/01/2011
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Last Update Date | 08/01/2011
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Provider Practice Location Address
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Address Line | 2922 SEA OATS CIR
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118-5938
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Country | US
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Telephone | 386-871-4515
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Fax |
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Provider Business Mailing Address
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Address Line | 2922 SEA OATS CIR
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118-5938
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Country | US
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Telephone | 386-871-4515
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARCELLA SCACCIA
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Credential | M.D.
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Telephone | 386-871-4515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 109319
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License Number State | FL
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