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General NPI Number Information
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NPI Number | 1861290611
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Entity Type | Organization
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Legal Business Name | VITAL HYDRATION & WELLNESS
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Dates
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Enumeration Date | 03/06/2025
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 26945 BROOKPARK ROAD EXT
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3176
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Country | US
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Telephone | 440-755-2414
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Fax |
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Provider Business Mailing Address
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Address Line | 4741 WESTVIEW DR
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-3478
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Country | US
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Telephone | 440-755-2414
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAJA SHAHEEN
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Credential | NP
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Telephone | 440-897-2169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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