Provider Demographics
NPI:1275008716
Name:CENTRAL FLORIDA WELLNESS LLC
Entity Type:Organization
Organization Name:CENTRAL FLORIDA WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHORTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-226-2993
Mailing Address - Street 1:7932 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-7263
Mailing Address - Country:US
Mailing Address - Phone:407-226-2993
Mailing Address - Fax:407-226-2996
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 131
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2633
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:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty