Provider Demographics
NPI:1720314818
Name:MANELLA HEALTH & WELLNESS PA
Entity type:Organization
Organization Name:MANELLA HEALTH & WELLNESS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-381-8989
Mailing Address - Street 1:700 N HIATUS RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-5206
Mailing Address - Country:US
Mailing Address - Phone:954-381-8989
Mailing Address - Fax:954-381-8950
Practice Address - Street 1:700 N HIATUS RD
Practice Address - Street 2:SUITE 209
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-5206
Practice Address - Country:US
Practice Address - Phone:954-381-8989
Practice Address - Fax:954-381-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty