MEDICARE: PALM BEACH WELLNESS 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	261Q00000X	Clinic/Center	ME79337	FL

General Provider Information

NPI Number	:	1376086082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALM BEACH WELLNESS LLC

Provider Business Mailing Address
First Line	:	2645 N FEDERAL HWY
Second Line	:	STE 120
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6100
Country	:	US
Telephone Number	:	561-740-2004
Fax Number	:

Provider Business Practice Location Address
First Line	:	2645 N FEDERAL HWY
Second Line	:	STE 120
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6100
Country	:	US
Telephone Number	:	561-740-2004
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CHRISTINE SHIM
Credential	:	MD
Telephone Number	:	561-740-2004

Provider Enumeration Date	:	11/29/2016
Last Update Date	:	11/29/2016

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Directions to “PALM BEACH WELLNESS LLC ” Practice Location

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