MEDICARE: INSTITUTE OF ETERNAL WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	133N00000X	Nutritionist
2	374K00000X	Religious Nonmedical Practitioner
3	374J00000X	Doula

General Provider Information

NPI Number	:	1154694511
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF ETERNAL WELLNESS

Provider Business Mailing Address
First Line	:	2522 S BELLFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1411
Country	:	US
Telephone Number	:	267-266-1320
Fax Number	:

Provider Business Practice Location Address
First Line	:	2522 S BELLFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-1411
Country	:	US
Telephone Number	:	267-266-1320
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS SHANIKA MALCOLM
Credential	:	RYT, RM, ND
Telephone Number	:	267-266-1320

Provider Enumeration Date	:	02/15/2012
Last Update Date	:	02/15/2012

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Directions to “INSTITUTE OF ETERNAL WELLNESS ” Practice Location

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