Family Wellness Center of Charleston, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1175 Issued in SC

Legal business name

FAMILY WELLNESS CENTER OF CHARLESTON, LLC

Practice address

9217 University Blvd
C1B
North Charleston, SC 29406-9147

Phone

(843) 729-8269

NPI assigned

Jan 27, 2015

Last updated

Jan 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stania A Dejesus, DONPI 1205097516

Title

Owner

Phone

(843) 729-8269

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stania Ayanna Dejesus, D.O

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1205097516
  NPD Authorized official

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

{
    "created_epoch": "1422316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422316800000",
    "number": "1619367745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9217 UNIVERSITY BLVD",
            "address_2": "C1B",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069147",
            "telephone_number": "843-729-8269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9217 UNIVERSITY BLVD",
            "address_2": "C1B",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294069147",
            "telephone_number": "843-729-8269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY WELLNESS CENTER OF CHARLESTON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-27",
        "last_updated": "2015-01-27",
        "status": "A",
        "authorized_official_last_name": "DEJESUS",
        "authorized_official_first_name": "STANIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-729-8269",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "SC",
            "license": "1175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family Laser Dental of North Charleston
• Family Laser Dental of North Charleston LLC
• Family Orthodontics of S. Carolina, LLC
• Family Services, Inc.
• Family Wellness Center of Charleston
• Penny Fanning, FNP
• Miriam Fanous, PT, DPT
• Guillaume Farah
• Courtney Farnham, RN
• Kimberly Seegers Fasanaro, RN

• Clinic/Center in North Charleston, SC
• Providers in North Charleston, SC by specialty
• Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; 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.