Provider Demographics
NPI:1710734975
Name:MY WELLNESS PRACTICE
Entity type:Organization
Organization Name:MY WELLNESS PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUMAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGVANI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:954-439-4333
Mailing Address - Street 1:12505 ORANGE DR STE 905
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4300
Mailing Address - Country:US
Mailing Address - Phone:954-839-6002
Mailing Address - Fax:954-539-6002
Practice Address - Street 1:12505 ORANGE DR STE 905
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4300
Practice Address - Country:US
Practice Address - Phone:954-839-6002
Practice Address - Fax:954-539-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-03
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty