MEDICARE: MY SELF WELLNESS INS 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	2084N0400X	Neurology Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1861358764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY SELF WELLNESS INS LLC

Provider Business Mailing Address
First Line	:	3541 BONITA BAY BLVD STE 100
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-1703
Country	:	US
Telephone Number	:	239-908-9958
Fax Number	:	239-319-5729

Provider Business Practice Location Address
First Line	:	3541 BONITA BAY BLVD STE 100
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-1703
Country	:	US
Telephone Number	:	239-908-9958
Fax Number	:	239-319-5729

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JESSICA SEIBERT
Credential	:
Telephone Number	:	239-908-9958

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/09/2026

Similar Medicare Providers

1215522263 — REVIVE RECOVERY LLC
Practice Location Address:

3541 BONITA BAY BLVD STE 200
BONITA SPRINGS, FL
34134-1703

Practice Phone: 239-908-9958
Practice Fax:

1295853141 — DR. PAMELA CANDACE HALE MD
Practice Location Address:

215 DAYTON ST APT 1
YELLOW SPRINGS, OH
45387-1703

Practice Phone: 937-689-6096
Practice Fax:

1578874095 — D'ARTHANA LORENZO BURRELL PMHNP-BC
Practice Location Address:

5840 RED BUG LAKE RD # 1703
WINTER SPRINGS, FL
32708-5011

Practice Phone: 954-205-3731
Practice Fax: 954-800-7911

1134413545 — CENTRACARE CORPORATION
Practice Location Address:

1703 BLUFFVIEW DR
BALCH SPRINGS, TX
75180-4829

Practice Phone: 972-288-1317
Practice Fax:

1588105423 — ROYALTECH, LLC
Practice Location Address:

1703 E CACHE LA POUDRE ST
COLORADO SPRINGS, CO
80909-4613

Practice Phone: 719-646-8056
Practice Fax:

1710401005 — JONATHAN BRUCE R.T.(R)(ARRT)
Practice Location Address:

1703 E CACHE LA POUDRE ST
COLORADO SPRINGS, CO
80909-4613

Practice Phone: 719-822-1532
Practice Fax:

Directions to “MY SELF WELLNESS INS LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.