NPIMap

Organization Active NPI

Central Florida Wellness LLC

  • General Practice Physician
  • Lake Mary, FL
National Provider Identifier
1871140988
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
CENTRAL FLORIDA WELLNESS LLC
Practice address
1061 S Sun Drove
Suite 1041
Lake. Mary, FL 32746
Phone
(407) 226-2993
Fax
(407) 226-2996
NPI assigned
Aug 22, 2019
Last updated
Aug 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Authorized official

Name
John T Shortly
Title
Owner
Phone
(863) 559-3434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

1061 S Sun Drove
Suite 1041
Lake. Mary, FL 32746

Mailing address

8081 Turkey Lake Rd Ste 650
Orlando, FL 32819-7321
Phone (407) 226-2993

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2173866Central Florida Wellness LLC1061 S Sun Dr #1041, Lake Mary, FL 32746Certificate of waiverOct 20, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central Florida Wellness LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1061 S Sun Dr
Ste 1041
Lake Mary, FL 32746
Phone (407) 226-2993

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1566432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566432000000",
    "number": "1871140988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8081 TURKEY LAKE RD STE 650",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328197321",
            "telephone_number": "407-226-2993",
            "fax_number": "407-226-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 S SUN DROVE",
            "address_2": "SUITE 1041",
            "city": "LAKE. MARY",
            "state": "FL",
            "postal_code": "32746",
            "telephone_number": "407-226-2993",
            "fax_number": "407-226-2996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL FLORIDA WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-22",
        "last_updated": "2019-08-22",
        "status": "A",
        "authorized_official_last_name": "SHORTLY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-559-3434"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.