MEDICARE: NEUROWELL HEALTH LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1275491730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEUROWELL HEALTH LLC

Provider Business Mailing Address
First Line	:	701 W AZEELE ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2337
Country	:	US
Telephone Number	:	813-444-3498
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 W AZEELE ST STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-2337
Country	:	US
Telephone Number	:	813-444-3498
Fax Number	:

Authorized Official
Title or Position	:	MBR
Name	:	CRISTY RUSSO
Credential	:	PHD
Telephone Number	:	813-444-3498

Provider Enumeration Date	:	01/13/2026
Last Update Date	:	06/15/2026

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Directions to “NEUROWELL HEALTH LLC ” Practice Location

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