MEDICARE: PARAMOUNT WELLNESS COLLABORATIVE, INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1790584308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARAMOUNT WELLNESS COLLABORATIVE, INC

Provider Business Mailing Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 117
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5232
Country	:	US
Telephone Number	:	904-203-4700
Fax Number	:	844-329-0848

Provider Business Practice Location Address
First Line	:	13241 BARTRAM PARK BLVD UNIT 117
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5232
Country	:	US
Telephone Number	:	904-203-4700
Fax Number	:	844-329-0848

Authorized Official
Title or Position	:	PRESIDENT/FOUNDER/OWNER
Name	:	SHANIQUE AMPIAH
Credential	:	MD
Telephone Number	:	561-312-6698

Provider Enumeration Date	:	03/08/2025
Last Update Date	:	05/12/2026

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