NPIMap

Organization Active NPI

Embracing Life Wellness Center, PA

  • Psychiatry Physician
  • Riverview, FL
National Provider Identifier
1083063176
Registry record updated Jun 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
ME96297 Issued in FL
Legal business name
EMBRACING LIFE WELLNESS CENTER, PA
Practice address
6332 US Highway 301 S
Riverview, FL 33578-3829
Phone
(813) 662-5919
Fax
(813) 671-8374
NPI assigned
Jun 9, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Melissa Dawn Fickey, M.D.NPI 1700951985
Title
Ceo
Phone
(813) 662-5919

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X ME96297 FL Primary

Addresses

Primary practice location

6332 US Highway 301 S
Riverview, FL 33578-3829

Mailing address

6332 US Highway 301 S
Riverview, FL 33578-3829
Phone (813) 662-5919

Other names 1

  • Melissa Vilardebo, MD, PA Former legal business name

National Provider Directory

National Provider Directory

Locations

6332 US Highway 301 S
Riverview, FL 33578
Phone (813) 662-5919

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465430400000",
    "number": "1083063176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6332 US HIGHWAY 301 S",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783829",
            "telephone_number": "813-662-5919",
            "fax_number": "813-671-8374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6332 US HIGHWAY 301 S",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335783829",
            "telephone_number": "813-662-5919",
            "fax_number": "813-671-8374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMBRACING LIFE WELLNESS CENTER, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-09",
        "last_updated": "2016-06-09",
        "status": "A",
        "authorized_official_last_name": "FICKEY",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "813-662-5919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME96297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Melissa Vilardebo, MD, PA",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Riverview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.