MEDICARE: REVIVAL HEALTH & 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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1891572145
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVAL HEALTH & WELLNESS LLC

Provider Business Mailing Address
First Line	:	6801 COLLINS AVE STE C1005
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3243
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 COLLINS AVE STE C1005
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33141-3243
Country	:	US
Telephone Number	:	732-929-8767
Fax Number	:

Authorized Official
Title or Position	:	OFFICE INCHARGE
Name	:	MR. ARVINDER SINGH
Credential	:
Telephone Number	:	732-929-8765

Provider Enumeration Date	:	09/11/2023
Last Update Date	:	07/25/2024

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