MEDICARE: SERENITY SHORE 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1669334223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERENITY SHORE WELLNESS LLC

Provider Business Mailing Address
First Line	:	3339 HANDY RD APT 211
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-4623
Country	:	US
Telephone Number	:	813-808-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	3339 HANDY RD APT 211
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618
Country	:	US
Telephone Number	:	818-808-0096
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	MARIA ALEJANDRA ALEJANDRA ZULUAGA DIAZ
Credential	:	LCSW
Telephone Number	:	813-808-0096

Provider Enumeration Date	:	12/02/2025
Last Update Date	:	12/02/2025

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