Revival IV and Wellness Clinic LLC
NPI #1033974878 in Shelton, Connecticut
Provider Information
- NPI Number
- 1033974878
- Entity Type
- Organization
- Organization Name
- Revival IV and Wellness Clinic LLC
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Feb 20, 2024
- Last Updated
- Feb 20, 2024
Practice Location
- Address
- 12 PROGRESS DR STE 1D
- City
- Shelton
- State
- Connecticut
- ZIP Code
- 06484-6290
- Phone
- (475) 314-3011
Authorized Official
- Name
- KEISHA ASANTE
- Title
- FNP
- Phone
- (475) 314-3011
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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