MEDICARE: STRIVE MEDICAL WELLNESS PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1598646630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRIVE MEDICAL WELLNESS PC

Provider Business Mailing Address
First Line	:	32 LAWRENCE AVE STE 206
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3605
Country	:	US
Telephone Number	:	631-265-1763
Fax Number	:	631-265-9014

Provider Business Practice Location Address
First Line	:	32 LAWRENCE AVE STE 206
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-3605
Country	:	US
Telephone Number	:	631-265-1763
Fax Number	:	631-265-9014

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEPHANIE WALLMAN
Credential	:	DO
Telephone Number	:	631-265-1763

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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