Healthcare Provider Details

I. General information

NPI: 1134936800
Provider Name (Legal Business Name): SOPHIA KAYATTA NBC-HWC, CHES, CPT,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 KENNETH CT
NEWARK DE
19711-8504
US

IV. Provider business mailing address

192 KENNETH CT
NEWARK DE
19711-8504
US

V. Phone/Fax

Practice location:
  • Phone: 302-500-1684
  • Fax:
Mailing address:
  • Phone: 302-500-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number39591
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3974094
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: