Healthcare Provider Details

I. General information

NPI: 1326943457
Provider Name (Legal Business Name): WETELEHEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 WOODLINE DR
DELAND FL
32720-6554
US

IV. Provider business mailing address

1279 WOODLINE DR
DELAND FL
32720-6554
US

V. Phone/Fax

Practice location:
  • Phone: 786-603-9515
  • Fax:
Mailing address:
  • Phone: 786-603-9515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MY NGA T HO
Title or Position: FOUNDER
Credential: WHNP-BC
Phone: 786-603-9515