Provider Demographics
NPI:1154088391
Name:FLUID HYDRATION & WELLNESS, PLLC
Entity Type:Organization
Organization Name:FLUID HYDRATION & WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-258-3722
Mailing Address - Street 1:401 HAWTHORNE LN STE 110200
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2484
Mailing Address - Country:US
Mailing Address - Phone:704-258-3722
Mailing Address - Fax:
Practice Address - Street 1:1630 OAKHURST COMMONS DR SUITE 201
Practice Address - Street 2:STE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6382
Practice Address - Country:US
Practice Address - Phone:704-258-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No251K00000XAgenciesPublic Health or Welfare