SW Florida Wellness Corp

NPI #1053733956 in Bonita Springs, Florida

Provider Information

NPI Number: 1053733956
Entity Type: Organization
Organization Name: SW Florida Wellness Corp
Primary Specialty: Dietitian, Registered
Enumeration Date: Jan 11, 2014
Last Updated: Jan 11, 2014

Practice Location

Address: 27499 RIVERVIEW CENTER BLVD
Address 2: SUITE 115
City: Bonita Springs
State: Florida
ZIP Code: 34134-4313
Phone: (239) 216-6556

Authorized Official

Name: MICHELE LICAUSI-SILANO, MA, MS, RD, LDM, RYT
Title: PRESIDENT
Phone: (201) 693-2224

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dietitian, Registered	133V00000X	Primary

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