MEDICARE: ELEVATE WELLNESS 369 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1649119736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELEVATE WELLNESS 369 LLC

Provider Business Mailing Address
First Line	:	9980 CENTRAL PARK BLVD N STE 314
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1704
Country	:	US
Telephone Number	:	561-404-1699
Fax Number	:	561-404-9850

Provider Business Practice Location Address
First Line	:	9980 CENTRAL PARK BLVD N STE 314
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1704
Country	:	US
Telephone Number	:	561-404-1699
Fax Number	:	561-404-9850

Authorized Official
Title or Position	:	OWNER AND CEO
Name	:	DR. GAYATRI SIRAM
Credential	:	MD
Telephone Number	:	561-315-0198

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

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