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General NPI Number Information
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NPI Number | 1578432266
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Entity Type | Organization
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Legal Business Name | SUPERIOR GENETIX HEALTH & WELLNESS, INC.
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Dates
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Enumeration Date | 11/01/2025
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Last Update Date | 11/01/2025
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Provider Practice Location Address
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Address Line | 3030 N ROCKY POINT DR W
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City | TAMPA
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State | FL
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Zip | 33607-5803
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Country | US
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Telephone | 727-275-0611
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Fax | 727-275-0611
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Provider Business Mailing Address
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Address Line | 7087 WEST BLVD STE 15
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City | BOARDMAN
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State | OH
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Zip | 44512-4335
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Country | US
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Telephone | 727-275-0611
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Fax | 727-275-0611
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Authorized Official
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Title or Position | OWNER / CEO
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Name | MR. RICH JAMES WYANT
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Credential | CLINICAL MANAGEMENT
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Telephone | 727-275-0611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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