MEDICARE: WELLNESS CENTER OF PALM BEACH HEALTH

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1942697503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS CENTER OF PALM BEACH HEALTH

Provider Business Mailing Address
First Line	:	2724 N AUSTRALIAN AVE BLDG 1
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4501
Country	:	US
Telephone Number	:	561-557-9298
Fax Number	:	888-570-6904

Provider Business Practice Location Address
First Line	:	2724 N AUSTRALIAN AVE BLDG 1
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-4501
Country	:	US
Telephone Number	:	561-557-9298
Fax Number	:	888-570-6904

Authorized Official
Title or Position	:	OWNER/CEO
Name	:	JAYEESH DAVE
Credential	:
Telephone Number	:	561-557-9298

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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