Provider Demographics
NPI:1336504786
Name:SOUTH FLORIDA WELLNESS NETWORK, INC
Entity Type:Organization
Organization Name:SOUTH FLORIDA WELLNESS NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NYAMORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-629-0405
Mailing Address - Street 1:2901 W CYPRESS CREEK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1730
Mailing Address - Country:US
Mailing Address - Phone:954-533-0585
Mailing Address - Fax:
Practice Address - Street 1:2901 W CYPRESS CREEK RD STE 105
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1730
Practice Address - Country:US
Practice Address - Phone:954-533-0585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health