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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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