| Organization Name: | SW FLORIDA WELLNESS CORP |
| NPI Number: | 1053733956 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHELE LICAUSI-SILANO (PRESIDENT) |
| Mailing Address: | 27499 Riverview Center Blvd Suite 115 Bonita Springs |
| State: | FL US |
| Postal Code: | 341344313 |
| Phone Number: | 2392166556 |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2014 |
| NPI Last Update Date: | 01/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 133V00000X |
| License Number: | ND5698 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Dietary & Nutritional Service Providers |
| Taxonomy Classification: | Dietitian, Registered |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor |