Provider Demographics
NPI:1376417477
Name:A RADIANCE WELLNESS, LLC
Entity type:Organization
Organization Name:A RADIANCE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALEEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-640-5072
Mailing Address - Street 1:9636 PIPER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6830
Mailing Address - Country:US
Mailing Address - Phone:317-640-5072
Mailing Address - Fax:317-640-5072
Practice Address - Street 1:9636 PIPER LAKE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-6830
Practice Address - Country:US
Practice Address - Phone:317-640-5072
Practice Address - Fax:317-640-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty