Provider Demographics
NPI:1093557290
Name:VITAL WELLNESS & AESTHETICS
Entity type:Organization
Organization Name:VITAL WELLNESS & AESTHETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:954-328-0982
Mailing Address - Street 1:8240 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-4515
Mailing Address - Country:US
Mailing Address - Phone:561-371-6019
Mailing Address - Fax:
Practice Address - Street 1:8240 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4515
Practice Address - Country:US
Practice Address - Phone:561-371-6019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center