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Organization
SW FLORIDA WELLNESS CORP
Active
Organization
SW FLORIDA WELLNESS CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE LICAUSI-SILANO MA, MS, RD, LDM, RYT (PRESIDENT)
(201) 693-2224
Entity
Organization
Contact information
Practice address
27499 RIVERVIEW CENTER BLVD, SUITE 115, BONITA SPRINGS, FL 34134-4313
(239) 216-6556
Mailing address
215 TOPANGA DR, BONITA SPRINGS, FL 34134-8545
(239) 216-6556
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
ND5698
FL
Other
Enumeration date
01/11/2014
Last updated
01/11/2014
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