Provider Demographics
NPI:1790584308
Name:PARAMOUNT WELLNESS COLLABORATIVE, INC
Entity type:Organization
Organization Name:PARAMOUNT WELLNESS COLLABORATIVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMPIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-312-6698
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:904-203-4700
Mailing Address - Fax:
Practice Address - Street 1:1629 RACE TRACK RD STE 102
Practice Address - Street 2:
Practice Address - City:ST JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-6299
Practice Address - Country:US
Practice Address - Phone:904-203-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-08
Last Update Date:2025-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)