MEDICARE: FLUID HYDRATION & WELLNESS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency
2	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1154088391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLUID HYDRATION & WELLNESS, PLLC

Provider Business Mailing Address
First Line	:	401 HAWTHORNE LN STE 110200
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2484
Country	:	US
Telephone Number	:	704-258-3722
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 OAKHURST COMMONS DR SUITE 201
Second Line	:	STE 110
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-6382
Country	:	US
Telephone Number	:	704-258-3722
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CYNTHIA AMBROISE
Credential	:
Telephone Number	:	704-258-3722

Provider Enumeration Date	:	11/22/2021
Last Update Date	:	09/06/2023

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