Provider Demographics
NPI:1639503899
Name:SANIBEL WELLNESS
Entity type:Organization
Organization Name:SANIBEL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-565-9529
Mailing Address - Street 1:16680 MCGREGOR BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3826
Mailing Address - Country:US
Mailing Address - Phone:239-395-1100
Mailing Address - Fax:
Practice Address - Street 1:16680 MCGREGOR BLVD STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3826
Practice Address - Country:US
Practice Address - Phone:239-395-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM28453261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service