Healthcare Provider Details

I. General information

NPI: 1376456053
Provider Name (Legal Business Name): EVERWELL LUXE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BROADWAY # 1
KISSIMMEE FL
34741-5711
US

IV. Provider business mailing address

39873 HIGHWAY 27
DAVENPORT FL
33837-7802
US

V. Phone/Fax

Practice location:
  • Phone: 863-206-9696
  • Fax:
Mailing address:
  • Phone: 863-206-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAVONA BUTLER
Title or Position: OWNER
Credential:
Phone: 863-206-9696