Provider Demographics
NPI:1730844002
Name:CENTRAL FLORIDA WELLNESS LLC
Entity type:Organization
Organization Name:CENTRAL FLORIDA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTH OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SHORTLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-559-3434
Mailing Address - Street 1:8081 TURKEY LAKE RD STE 650
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7321
Mailing Address - Country:US
Mailing Address - Phone:407-226-2993
Mailing Address - Fax:407-226-2996
Practice Address - Street 1:5559 E SR 44
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-8282
Practice Address - Country:US
Practice Address - Phone:407-226-2993
Practice Address - Fax:407-226-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty