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General NPI Number Information
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NPI Number | 1831036284
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Entity Type | Organization
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Legal Business Name | HEALTH AND WELLNESS OF MI LLC
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 220 W CONGRESS ST # 513
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City | DETROIT
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State | MI
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Zip | 48226-3289
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Country | US
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Telephone | 702-683-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 220 W CONGRESS ST # 513
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City | DETROIT
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State | MI
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Zip | 48226-3289
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHAKAUWRA SANDOVAL
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Credential |
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Telephone | 702-683-9050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133VN1201X
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Taxonomy Name | Obesity and Weight Management Nutrition Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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