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General NPI Number Information
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NPI Number | 1649119736
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Entity Type | Organization
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Legal Business Name | ELEVATE WELLNESS 369 LLC
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Dates
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Enumeration Date | 03/25/2026
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Last Update Date | 03/25/2026
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Provider Practice Location Address
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Address Line | 9980 CENTRAL PARK BLVD N STE 314
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City | BOCA RATON
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State | FL
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Zip | 33428-1704
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Country | US
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Telephone | 561-404-1699
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Fax | 561-404-9850
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Provider Business Mailing Address
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Address Line | 9980 CENTRAL PARK BLVD N STE 314
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City | BOCA RATON
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State | FL
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Zip | 33428-1704
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Country | US
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Telephone | 561-404-1699
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Fax | 561-404-9850
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Authorized Official
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Title or Position | OWNER AND CEO
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Name | DR. GAYATRI SIRAM
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Credential | MD
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Telephone | 561-315-0198
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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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