OrganizationActive
Brevard Wellness Clinc 1 LLC
NPI 1043633795 · Internal Medicine Physician · Palm Bay, FL
Provider details
- NPI number
- 1043633795
- Entity type
- Organization
- Primary specialty
- Internal Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Srinivas Dontineni, President(321) 751-9506
- License
- ME88036 (FL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(76/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
12 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1264 Malabar Rd Se
Palm Bay, FL 32907-2556
Phone: (321) 751-9506
Fax: (321) 751-9505
Street-level locationGet directions
Mailing address
1264 Malabar Rd Se
Palm Bay, FL 32907-2556
Registry dates
- Enumerated
- 2014-01-31
- Last updated
- 2014-01-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.